{ "hospital_name": "Northwestern Medicine Kishwaukee Hospital", "last_updated_on": "2026-04-01", "version": "3.0.0", "location_name": [ "Northwestern Medicine Kishwaukee Hospital" ], "hospital_address": [ "1 Kish Hospital Drive, DeKalb, IL 60115" ], "license_information": { "license_number": "0005470", "state": "IL" }, "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": "John Orsini" }, "type_2_npi": [ "1669534517", "1881758126" ], "standard_charge_information": [ { "description": "1.5MM TI CORTEX SCREW SELF-TAPPING 6MM", "code_information": [ { "code": "SUP-49999", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 80.0, "maximum": 437.17, "setting": "outpatient", "gross_charge": 437.17, "discounted_cash": 306.02, "payers_information": [ { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 6.9% = $30.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 230.39, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3377.8, "10th_percentile": 3377.8, "90th_percentile": 3377.8, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 80.0, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 840.84, "10th_percentile": 840.84, "90th_percentile": 840.84, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 375.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 375.97, "10th_percentile": 375.97, "90th_percentile": 375.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 375.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 375.97, "10th_percentile": 375.97, "90th_percentile": 375.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 375.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 375.97, "10th_percentile": 375.97, "90th_percentile": 375.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 375.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 375.97, "10th_percentile": 375.97, "90th_percentile": 375.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 264.05, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 264.05, "10th_percentile": 264.05, "90th_percentile": 264.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 264.05, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 264.05, "10th_percentile": 264.05, "90th_percentile": 264.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 264.05, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 264.05, "10th_percentile": 264.05, "90th_percentile": 264.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 290.24, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 290.24, "10th_percentile": 290.24, "90th_percentile": 290.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 290.24, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 290.24, "10th_percentile": 290.24, "90th_percentile": 290.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 437.17, "10th_percentile": 437.17, "90th_percentile": 437.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 437.17, "10th_percentile": 437.17, "90th_percentile": 437.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 196.73, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 196.73, "10th_percentile": 196.73, "90th_percentile": 196.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 327.88, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 327.88, "10th_percentile": 327.88, "90th_percentile": 327.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 437.17, "10th_percentile": 437.17, "90th_percentile": 437.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 330.5, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 330.5, "10th_percentile": 330.5, "90th_percentile": 330.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 232.14, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 232.14, "10th_percentile": 232.14, "90th_percentile": 232.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 284.16, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 284.16, "10th_percentile": 284.16, "90th_percentile": 284.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 402.2, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 402.2, "10th_percentile": 402.2, "90th_percentile": 402.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 244.38, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 244.38, "10th_percentile": 244.38, "90th_percentile": 244.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 437.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 437.17, "10th_percentile": 437.17, "90th_percentile": 437.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 219.46, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 219.46, "10th_percentile": 219.46, "90th_percentile": 219.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 340.99, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 340.99, "10th_percentile": 340.99, "90th_percentile": 340.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 292.47, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11985.07, "10th_percentile": 11985.07, "90th_percentile": 11985.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 156.94, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 2724.23, "10th_percentile": 2724.23, "90th_percentile": 2724.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 294.65, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 294.65, "10th_percentile": 294.65, "90th_percentile": 294.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 328.31, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 328.31, "10th_percentile": 328.31, "90th_percentile": 328.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 148.64, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 148.64, "10th_percentile": 148.64, "90th_percentile": 148.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 310.39, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 310.39, "10th_percentile": 310.39, "90th_percentile": 310.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 310.39, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 310.39, "10th_percentile": 310.39, "90th_percentile": 310.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 11.5% = $50.27 due to $0.00 Claim Price", "median_amount": 50.27, "10th_percentile": 50.27, "90th_percentile": 50.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 11.5% = $50.27 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 11.5% = $50.27 due to $0.00 Claim Price", "median_amount": 50.27, "10th_percentile": 50.27, "90th_percentile": 50.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $437.17 @ 11.5% = $50.27 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.17, "10th_percentile": 437.17, "90th_percentile": 437.17, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "21GA X 15CM NEEDLE PERC ENTRY ECHOTP W/O BASEPLT", "code_information": [ { "code": "SUP-150868", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 3.69, "maximum": 20.15, "setting": "outpatient", "gross_charge": 20.15, "discounted_cash": 14.1, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 17.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 17.33, "10th_percentile": 17.33, "90th_percentile": 17.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 17.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 17.33, "10th_percentile": 17.33, "90th_percentile": 17.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 17.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 17.33, "10th_percentile": 17.33, "90th_percentile": 17.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 17.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 17.33, "10th_percentile": 17.33, "90th_percentile": 17.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 12.39, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.39, "10th_percentile": 12.39, "90th_percentile": 12.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 15.4, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.4, "10th_percentile": 15.4, "90th_percentile": 15.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 11.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.26, "10th_percentile": 11.26, "90th_percentile": 11.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 13.38, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 13.38, "10th_percentile": 13.38, "90th_percentile": 13.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 11.8, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.8, "10th_percentile": 11.8, "90th_percentile": 11.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 11.8, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.8, "10th_percentile": 11.8, "90th_percentile": 11.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.69, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 3.69, "10th_percentile": 3.69, "90th_percentile": 3.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 7.23, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 7.23, "10th_percentile": 7.23, "90th_percentile": 7.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 13.58, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.58, "10th_percentile": 13.58, "90th_percentile": 13.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 6.85, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 6.85, "10th_percentile": 6.85, "90th_percentile": 6.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 15.13, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.13, "10th_percentile": 15.13, "90th_percentile": 15.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 20.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 13.48, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.48, "10th_percentile": 13.48, "90th_percentile": 13.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 18.54, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 18.54, "10th_percentile": 18.54, "90th_percentile": 18.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 10.62, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.62, "10th_percentile": 10.62, "90th_percentile": 10.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 10.7, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.7, "10th_percentile": 10.7, "90th_percentile": 10.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 15.72, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 15.72, "10th_percentile": 15.72, "90th_percentile": 15.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 9.07, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 9.07, "10th_percentile": 9.07, "90th_percentile": 9.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 13.38, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 13.38, "10th_percentile": 13.38, "90th_percentile": 13.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 15.11, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 15.11, "10th_percentile": 15.11, "90th_percentile": 15.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 15.4, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.4, "10th_percentile": 15.4, "90th_percentile": 15.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 13.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 13.1, "10th_percentile": 13.1, "90th_percentile": 13.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 10.12, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.12, "10th_percentile": 10.12, "90th_percentile": 10.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 15.23, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 15.23, "10th_percentile": 15.23, "90th_percentile": 15.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.15, "10th_percentile": 20.15, "90th_percentile": 20.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "6F 13CM INTRO SYS W/INFUS SIDE PORT SAFESHEATH II", "code_information": [ { "code": "SUP-358902", "type": "CDM" }, { "code": "C1892", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 97.5, "maximum": 532.78, "setting": "outpatient", "gross_charge": 532.78, "discounted_cash": 372.95, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 532.78, "10th_percentile": 532.78, "90th_percentile": 532.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 532.78, "10th_percentile": 532.78, "90th_percentile": 532.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 378.27, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 378.27, "10th_percentile": 378.27, "90th_percentile": 378.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 378.27, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 378.27, "10th_percentile": 378.27, "90th_percentile": 378.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 97.5, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 97.5, "10th_percentile": 97.5, "90th_percentile": 97.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 181.15, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 181.15, "10th_percentile": 181.15, "90th_percentile": 181.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 191.27, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 191.27, "10th_percentile": 191.27, "90th_percentile": 191.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 400.12, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 400.12, "10th_percentile": 400.12, "90th_percentile": 400.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 359.09, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 359.09, "10th_percentile": 359.09, "90th_percentile": 359.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 402.78, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 402.78, "10th_percentile": 402.78, "90th_percentile": 402.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 282.91, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 282.91, "10th_percentile": 282.91, "90th_percentile": 282.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 280.78, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 280.78, "10th_percentile": 280.78, "90th_percentile": 280.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 490.16, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 490.16, "10th_percentile": 490.16, "90th_percentile": 490.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 239.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 239.75, "10th_percentile": 239.75, "90th_percentile": 239.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 399.59, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 399.59, "10th_percentile": 399.59, "90th_percentile": 399.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 415.57, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 415.57, "10th_percentile": 415.57, "90th_percentile": 415.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 532.78, "10th_percentile": 532.78, "90th_percentile": 532.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 346.31, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 346.31, "10th_percentile": 346.31, "90th_percentile": 346.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 267.46, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 267.46, "10th_percentile": 267.46, "90th_percentile": 267.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 356.43, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 356.43, "10th_percentile": 356.43, "90th_percentile": 356.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 532.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 532.78, "10th_percentile": 532.78, "90th_percentile": 532.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 297.82, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 297.82, "10th_percentile": 297.82, "90th_percentile": 297.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 353.71, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 353.71, "10th_percentile": 353.71, "90th_percentile": 353.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 353.71, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 353.71, "10th_percentile": 353.71, "90th_percentile": 353.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 321.8, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 321.8, "10th_percentile": 321.8, "90th_percentile": 321.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 321.8, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 321.8, "10th_percentile": 321.8, "90th_percentile": 321.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 321.8, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 321.8, "10th_percentile": 321.8, "90th_percentile": 321.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 458.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 458.19, "10th_percentile": 458.19, "90th_percentile": 458.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 458.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 458.19, "10th_percentile": 458.19, "90th_percentile": 458.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 458.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 458.19, "10th_percentile": 458.19, "90th_percentile": 458.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 458.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 458.19, "10th_percentile": 458.19, "90th_percentile": 458.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.76, "10th_percentile": 36.76, "90th_percentile": 36.76, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.76, "10th_percentile": 36.76, "90th_percentile": 36.76, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.76, "10th_percentile": 36.76, "90th_percentile": 36.76, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.76, "10th_percentile": 36.76, "90th_percentile": 36.76, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.76, "10th_percentile": 36.76, "90th_percentile": 36.76, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.76, "10th_percentile": 36.76, "90th_percentile": 36.76, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.76, "10th_percentile": 36.76, "90th_percentile": 36.76, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 6.9% = $36.76 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 11.5% = $61.27 due to $0.00 Claim Price", "median_amount": 61.27, "10th_percentile": 61.27, "90th_percentile": 61.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 11.5% = $61.27 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 11.5% = $61.27 due to $0.00 Claim Price", "median_amount": 61.27, "10th_percentile": 61.27, "90th_percentile": 61.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $532.78 @ 11.5% = $61.27 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 532.78, "10th_percentile": 532.78, "90th_percentile": 532.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN", "drug_information": { "unit": 65.0, "type": "ML" }, "code_information": [ { "code": "RX-186132", "type": "CDM" }, { "code": "J0131", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "24201-0100-24", "type": "NDC" } ], "standard_charges": [ { "minimum": 47.26, "maximum": 258.25, "setting": "outpatient", "gross_charge": 258.25, "discounted_cash": 180.77, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 11.5% = $29.70 due to $0.00 Claim Price", "median_amount": 29.7, "10th_percentile": 29.7, "90th_percentile": 29.7, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 11.5% = $29.70 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 11.5% = $29.70 due to $0.00 Claim Price", "median_amount": 29.7, "10th_percentile": 29.7, "90th_percentile": 29.7, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 11.5% = $29.70 due to $0.00 Claim Price" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $258.25 @ 6.9% = $17.82 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 222.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 222.1, "10th_percentile": 222.1, "90th_percentile": 222.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 222.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 222.1, "10th_percentile": 222.1, "90th_percentile": 222.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 222.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 222.1, "10th_percentile": 222.1, "90th_percentile": 222.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 222.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 222.1, "10th_percentile": 222.1, "90th_percentile": 222.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 155.98, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 155.98, "10th_percentile": 155.98, "90th_percentile": 155.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 155.98, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 155.98, "10th_percentile": 155.98, "90th_percentile": 155.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 155.98, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 155.98, "10th_percentile": 155.98, "90th_percentile": 155.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 171.45, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 171.45, "10th_percentile": 171.45, "90th_percentile": 171.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 171.45, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 171.45, "10th_percentile": 171.45, "90th_percentile": 171.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 183.36, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 183.36, "10th_percentile": 183.36, "90th_percentile": 183.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 183.36, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 183.36, "10th_percentile": 183.36, "90th_percentile": 183.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 47.26, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 87.81, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 87.81, "10th_percentile": 87.81, "90th_percentile": 87.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 92.71, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 195.24, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 195.24, "10th_percentile": 195.24, "90th_percentile": 195.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 193.69, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 193.69, "10th_percentile": 193.69, "90th_percentile": 193.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 237.59, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 237.59, "10th_percentile": 237.59, "90th_percentile": 237.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 116.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 116.21, "10th_percentile": 116.21, "90th_percentile": 116.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 201.44, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 201.44, "10th_percentile": 201.44, "90th_percentile": 201.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 144.36, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 144.36, "10th_percentile": 144.36, "90th_percentile": 144.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLN", "drug_information": { "unit": 10.15, "type": "ML" }, "code_information": [ { "code": "RX-181465", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "39328-0032-50", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.41, "maximum": 2.25, "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.26, "10th_percentile": 1.26, "90th_percentile": 1.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.38, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.38, "10th_percentile": 1.38, "90th_percentile": 1.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.32, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.32, "10th_percentile": 1.32, "90th_percentile": 1.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.32, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.32, "10th_percentile": 1.32, "90th_percentile": 1.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.72, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.52, "10th_percentile": 1.52, "90th_percentile": 1.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 0.81, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 0.77, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 0.77, "10th_percentile": 0.77, "90th_percentile": 0.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.41, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.41, "10th_percentile": 0.41, "90th_percentile": 0.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.72, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1.7, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1.7, "10th_percentile": 1.7, "90th_percentile": 1.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1.19, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.19, "10th_percentile": 1.19, "90th_percentile": 1.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1.19, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.19, "10th_percentile": 1.19, "90th_percentile": 1.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2.07, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2.07, "10th_percentile": 2.07, "90th_percentile": 2.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1.76, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1.76, "10th_percentile": 1.76, "90th_percentile": 1.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.51, "10th_percentile": 1.51, "90th_percentile": 1.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ACETIC ACID 0.25 % IRR SOLN", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "RX-8963", "type": "CDM" }, { "code": "27200000", "type": "LOCAL" }, { "code": "0272", "type": "RC" }, { "code": "00990-6143-09", "type": "NDC" } ], "standard_charges": [ { "minimum": 48.72, "maximum": 266.25, "setting": "outpatient", "gross_charge": 266.25, "discounted_cash": 186.37, "payers_information": [ { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 179.45, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 179.45, "10th_percentile": 179.45, "90th_percentile": 179.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 199.95, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 199.95, "10th_percentile": 199.95, "90th_percentile": 199.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 95.58, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 95.58, "10th_percentile": 95.58, "90th_percentile": 95.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 90.53, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 90.53, "10th_percentile": 90.53, "90th_percentile": 90.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 48.72, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 228.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 228.98, "10th_percentile": 228.98, "90th_percentile": 228.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 176.76, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 176.76, "10th_percentile": 176.76, "90th_percentile": 176.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 203.47, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 203.47, "10th_percentile": 203.47, "90th_percentile": 203.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 163.77, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 163.77, "10th_percentile": 163.77, "90th_percentile": 163.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 155.97, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 155.97, "10th_percentile": 155.97, "90th_percentile": 155.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 155.97, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 155.97, "10th_percentile": 155.97, "90th_percentile": 155.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 176.76, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 176.76, "10th_percentile": 176.76, "90th_percentile": 176.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 148.83, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 148.83, "10th_percentile": 148.83, "90th_percentile": 148.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 203.47, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 203.47, "10th_percentile": 203.47, "90th_percentile": 203.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 201.29, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 201.29, "10th_percentile": 201.29, "90th_percentile": 201.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 141.38, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 141.38, "10th_percentile": 141.38, "90th_percentile": 141.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 140.31, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.31, "10th_percentile": 140.31, "90th_percentile": 140.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 228.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 228.98, "10th_percentile": 228.98, "90th_percentile": 228.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 228.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 228.98, "10th_percentile": 228.98, "90th_percentile": 228.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 228.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 228.98, "10th_percentile": 228.98, "90th_percentile": 228.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 244.95, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 244.95, "10th_percentile": 244.95, "90th_percentile": 244.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 119.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 119.81, "10th_percentile": 119.81, "90th_percentile": 119.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 199.69, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 199.69, "10th_percentile": 199.69, "90th_percentile": 199.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 207.68, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 207.68, "10th_percentile": 207.68, "90th_percentile": 207.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 173.06, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 173.06, "10th_percentile": 173.06, "90th_percentile": 173.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 133.66, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 133.66, "10th_percentile": 133.66, "90th_percentile": 133.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 178.12, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 178.12, "10th_percentile": 178.12, "90th_percentile": 178.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 14095.04, "maximum": 37130.1, "setting": "inpatient", "gross_charge": 52049.5, "discounted_cash": 36434.65, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 44642.17, "10th_percentile": 44642.17, "90th_percentile": 44642.17, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 44642.17, "10th_percentile": 44642.17, "90th_percentile": 44642.17, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 44642.17, "10th_percentile": 44642.17, "90th_percentile": 44642.17, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 44642.17, "10th_percentile": 44642.17, "90th_percentile": 44642.17, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 51909.5, "10th_percentile": 51909.5, "90th_percentile": 51909.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 51909.5, "10th_percentile": 51909.5, "90th_percentile": 51909.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 51909.5, "10th_percentile": 51909.5, "90th_percentile": 51909.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services - OON; 100% Billed", "median_amount": 51909.5, "10th_percentile": 51909.5, "90th_percentile": 51909.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_percentage": 38.9, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; ALL INPATIENT; 38.9% Billed", "median_amount": 20192.8, "10th_percentile": 20192.8, "90th_percentile": 20192.8, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_percentage": 35.6, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All Inpatient Services; 35.6% Billed", "median_amount": 18479.78, "10th_percentile": 18479.78, "90th_percentile": 18479.78, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_percentage": 18.3, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 9499.44, "10th_percentile": 9499.44, "90th_percentile": 9499.44, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 23359.28, "10th_percentile": 23359.28, "90th_percentile": 23359.28, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_percentage": 92.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 47756.74, "10th_percentile": 47756.74, "90th_percentile": 47756.74, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_percentage": 76.1, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; Inpatient; 76.1% Billed", "median_amount": 39503.13, "10th_percentile": 39503.13, "90th_percentile": 39503.13, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; IP Services. ADP RATE (for patient estimates only); 49% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25435.66, "10th_percentile": 25435.66, "90th_percentile": 25435.66, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; Inpatient Services; 75% Billed", "median_amount": 38932.13, "10th_percentile": 38932.13, "90th_percentile": 38932.13, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_percentage": 78.0, "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 40489.41, "10th_percentile": 40489.41, "90th_percentile": 40489.41, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_dollar": 14095.04, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $16,218.47; Total: $16,218.47 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16218.47, "10th_percentile": 16218.47, "90th_percentile": 16218.47, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $16,218.47; Total: $16,218.47 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 14095.04, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $16,218.47; Total: $16,218.47", "median_amount": 16218.47, "10th_percentile": 16218.47, "90th_percentile": 16218.47, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $16,218.47; Total: $16,218.47" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 14095.04, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $16,218.47; Total: $16,218.47", "median_amount": 16218.47, "10th_percentile": 16218.47, "90th_percentile": 16218.47, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $16,218.47; Total: $16,218.47" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 29628.81, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29628.81, "10th_percentile": 29628.81, "90th_percentile": 29628.81, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37130.1, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37130.1, "10th_percentile": 37130.1, "90th_percentile": 37130.1, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 25784.07, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 13,017.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE PREF STOP LOSS & LESSOR OF 9.*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25784.07, "10th_percentile": 25784.07, "90th_percentile": 25784.07, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 29628.81, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29628.81, "10th_percentile": 29628.81, "90th_percentile": 29628.81, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 24555.98, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 12,397.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE SELECT STOP LOSS & LESSOR OF *; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24555.98, "10th_percentile": 24555.98, "90th_percentile": 24555.98, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37130.1, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37130.1, "10th_percentile": 37130.1, "90th_percentile": 37130.1, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 27501.43, "standard_charge_algorithm": "Re-evaluated: HLB.820478593; Using historical claim(s); Scope: All Financial Classes; Cases: 3; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 13,884.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27501.43, "10th_percentile": 27501.43, "90th_percentile": 27501.43, "count": "1 through 10", "methodology": "case rate" } ] } ] }, { "description": "ADAPTA S PACEMAKER", "code_information": [ { "code": "SUP-117685", "type": "CDM" }, { "code": "C1785", "type": "HCPCS" }, { "code": "0275", "type": "RC" } ], "standard_charges": [ { "minimum": 4802.22, "maximum": 26241.66, "setting": "outpatient", "gross_charge": 26241.66, "discounted_cash": 18369.16, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 22567.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 22567.83, "10th_percentile": 22567.83, "90th_percentile": 22567.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 22567.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 22567.83, "10th_percentile": 22567.83, "90th_percentile": 22567.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 22567.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 22567.83, "10th_percentile": 22567.83, "90th_percentile": 22567.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 22567.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 22567.83, "10th_percentile": 22567.83, "90th_percentile": 22567.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 26241.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 26241.66, "10th_percentile": 26241.66, "90th_percentile": 26241.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 26241.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 26241.66, "10th_percentile": 26241.66, "90th_percentile": 26241.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 26241.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 26241.66, "10th_percentile": 26241.66, "90th_percentile": 26241.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 24142.33, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 24142.33, "10th_percentile": 24142.33, "90th_percentile": 24142.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 20468.49, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 20468.49, "10th_percentile": 20468.49, "90th_percentile": 20468.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 19681.25, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 19681.25, "10th_percentile": 19681.25, "90th_percentile": 19681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 11808.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 11808.75, "10th_percentile": 11808.75, "90th_percentile": 11808.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 19838.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 19838.69, "10th_percentile": 19838.69, "90th_percentile": 19838.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 17057.08, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 17057.08, "10th_percentile": 17057.08, "90th_percentile": 17057.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 17421.84, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 17421.84, "10th_percentile": 17421.84, "90th_percentile": 17421.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 18631.58, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18631.58, "10th_percentile": 18631.58, "90th_percentile": 18631.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 13173.31, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13173.31, "10th_percentile": 13173.31, "90th_percentile": 13173.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 17555.67, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17555.67, "10th_percentile": 17555.67, "90th_percentile": 17555.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 13934.32, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13934.32, "10th_percentile": 13934.32, "90th_percentile": 13934.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 13829.35, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13829.35, "10th_percentile": 13829.35, "90th_percentile": 13829.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 17686.88, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17686.88, "10th_percentile": 17686.88, "90th_percentile": 17686.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 19707.49, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19707.49, "10th_percentile": 19707.49, "90th_percentile": 19707.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 4802.22, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 4802.22, "10th_percentile": 4802.22, "90th_percentile": 4802.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 8922.16, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 8922.16, "10th_percentile": 8922.16, "90th_percentile": 8922.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 9420.76, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 9420.76, "10th_percentile": 9420.76, "90th_percentile": 9420.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 18631.58, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18631.58, "10th_percentile": 18631.58, "90th_percentile": 18631.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 17421.84, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 17421.84, "10th_percentile": 17421.84, "90th_percentile": 17421.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 14669.09, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14669.09, "10th_percentile": 14669.09, "90th_percentile": 14669.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 26241.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 26241.66, "10th_percentile": 26241.66, "90th_percentile": 26241.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 15849.96, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15849.96, "10th_percentile": 15849.96, "90th_percentile": 15849.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 15849.96, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15849.96, "10th_percentile": 15849.96, "90th_percentile": 15849.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 15849.96, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15849.96, "10th_percentile": 15849.96, "90th_percentile": 15849.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1810.67, "10th_percentile": 1810.67, "90th_percentile": 1810.67, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1810.67, "10th_percentile": 1810.67, "90th_percentile": 1810.67, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1810.67, "10th_percentile": 1810.67, "90th_percentile": 1810.67, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1810.67, "10th_percentile": 1810.67, "90th_percentile": 1810.67, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1810.67, "10th_percentile": 1810.67, "90th_percentile": 1810.67, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1810.67, "10th_percentile": 1810.67, "90th_percentile": 1810.67, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1810.67, "10th_percentile": 1810.67, "90th_percentile": 1810.67, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 6.9% = $1,810.67 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 11.5% = $3,017.79 due to $0.00 Claim Price", "median_amount": 3017.79, "10th_percentile": 3017.79, "90th_percentile": 3017.79, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 11.5% = $3,017.79 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 11.5% = $3,017.79 due to $0.00 Claim Price", "median_amount": 3017.79, "10th_percentile": 3017.79, "90th_percentile": 3017.79, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,241.66 @ 11.5% = $3,017.79 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 26241.66, "10th_percentile": 26241.66, "90th_percentile": 26241.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 8013.14, "maximum": 21108.74, "setting": "inpatient", "gross_charge": 29244.5, "discounted_cash": 20471.15, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 25150.27, "10th_percentile": 25150.27, "90th_percentile": 25150.27, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 25150.27, "10th_percentile": 25150.27, "90th_percentile": 25150.27, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 25150.27, "10th_percentile": 25150.27, "90th_percentile": 25150.27, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 25150.27, "10th_percentile": 25150.27, "90th_percentile": 25150.27, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 29244.5, "10th_percentile": 29244.5, "90th_percentile": 29244.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; 100% Billed", "median_amount": 29244.5, "10th_percentile": 29244.5, "90th_percentile": 29244.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 29244.5, "10th_percentile": 29244.5, "90th_percentile": 29244.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services - OON; 100% Billed", "median_amount": 29244.5, "10th_percentile": 29244.5, "90th_percentile": 29244.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_percentage": 38.9, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; ALL INPATIENT; 38.9% Billed", "median_amount": 11376.11, "10th_percentile": 11376.11, "90th_percentile": 11376.11, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_percentage": 35.6, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All Inpatient Services; 35.6% Billed", "median_amount": 10411.04, "10th_percentile": 10411.04, "90th_percentile": 10411.04, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_percentage": 18.3, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 5351.74, "10th_percentile": 5351.74, "90th_percentile": 5351.74, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 13160.03, "10th_percentile": 13160.03, "90th_percentile": 13160.03, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_percentage": 92.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 26904.94, "10th_percentile": 26904.94, "90th_percentile": 26904.94, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_percentage": 76.1, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; Inpatient; 76.1% Billed", "median_amount": 22255.06, "10th_percentile": 22255.06, "90th_percentile": 22255.06, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; IP Services. ADP RATE (for patient estimates only); 49% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14329.81, "10th_percentile": 14329.81, "90th_percentile": 14329.81, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; Inpatient Services; 75% Billed", "median_amount": 21933.38, "10th_percentile": 21933.38, "90th_percentile": 21933.38, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_percentage": 78.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 22810.71, "10th_percentile": 22810.71, "90th_percentile": 22810.71, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_dollar": 8013.14, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Transfer payment: $5,345.07; Total: $5,345.07 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5345.07, "10th_percentile": 5345.07, "90th_percentile": 5345.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Transfer payment: $5,345.07; Total: $5,345.07 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 8013.14, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Transfer payment: $5,345.07; Total: $5,345.07", "median_amount": 5345.07, "10th_percentile": 5345.07, "90th_percentile": 5345.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Transfer payment: $5,345.07; Total: $5,345.07" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 8013.14, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Transfer payment: $5,345.07; Total: $5,345.07", "median_amount": 5345.07, "10th_percentile": 5345.07, "90th_percentile": 5345.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Transfer payment: $5,345.07; Total: $5,345.07" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 16844.2, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16844.2, "10th_percentile": 16844.2, "90th_percentile": 16844.2, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 21108.74, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21108.74, "10th_percentile": 21108.74, "90th_percentile": 21108.74, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 14658.44, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 13,017.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE PREF STOP LOSS & LESSOR OF 9.*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14658.44, "10th_percentile": 14658.44, "90th_percentile": 14658.44, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 16844.2, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16844.2, "10th_percentile": 16844.2, "90th_percentile": 16844.2, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 13960.26, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 12,397.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE SELECT STOP LOSS & LESSOR OF *; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13960.26, "10th_percentile": 13960.26, "90th_percentile": 13960.26, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 21108.74, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21108.74, "10th_percentile": 21108.74, "90th_percentile": 21108.74, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 15634.77, "standard_charge_algorithm": "Re-evaluated: HLB.800759243; Using historical claim(s); Scope: All Financial Classes; Cases: 7; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 13,884.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15634.77, "10th_percentile": 15634.77, "90th_percentile": 15634.77, "count": "1 through 10", "methodology": "case rate" } ] } ] }, { "description": "ALBUMIN, HUMAN 25 % IV SOLP", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-8981", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00944-0493-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 219.1, "maximum": 1197.25, "setting": "outpatient", "gross_charge": 1197.25, "discounted_cash": 838.07, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1197.25, "10th_percentile": 1197.25, "90th_percentile": 1197.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 11.5% = $137.68 due to $0.00 Claim Price", "median_amount": 137.68, "10th_percentile": 137.68, "90th_percentile": 137.68, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 11.5% = $137.68 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 11.5% = $137.68 due to $0.00 Claim Price", "median_amount": 137.68, "10th_percentile": 137.68, "90th_percentile": 137.68, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 11.5% = $137.68 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 82.61, "10th_percentile": 82.61, "90th_percentile": 82.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 82.61, "10th_percentile": 82.61, "90th_percentile": 82.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 82.61, "10th_percentile": 82.61, "90th_percentile": 82.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 82.61, "10th_percentile": 82.61, "90th_percentile": 82.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 82.61, "10th_percentile": 82.61, "90th_percentile": 82.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 82.61, "10th_percentile": 82.61, "90th_percentile": 82.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 82.61, "10th_percentile": 82.61, "90th_percentile": 82.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.25 @ 6.9% = $82.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1029.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1029.64, "10th_percentile": 1029.64, "90th_percentile": 1029.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1029.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1029.64, "10th_percentile": 1029.64, "90th_percentile": 1029.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1029.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1029.64, "10th_percentile": 1029.64, "90th_percentile": 1029.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1029.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1029.64, "10th_percentile": 1029.64, "90th_percentile": 1029.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 723.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 723.14, "10th_percentile": 723.14, "90th_percentile": 723.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 723.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 723.14, "10th_percentile": 723.14, "90th_percentile": 723.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 723.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 723.14, "10th_percentile": 723.14, "90th_percentile": 723.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1197.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 1197.25, "90th_percentile": 1197.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1197.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1197.25, "10th_percentile": 1197.25, "90th_percentile": 1197.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 794.85, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 794.85, "10th_percentile": 794.85, "90th_percentile": 794.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 794.85, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 794.85, "10th_percentile": 794.85, "90th_percentile": 794.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 850.05, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 850.05, "10th_percentile": 850.05, "90th_percentile": 850.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 850.05, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 850.05, "10th_percentile": 850.05, "90th_percentile": 850.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 219.1, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 219.1, "10th_percentile": 219.1, "90th_percentile": 219.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 407.07, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 407.07, "10th_percentile": 407.07, "90th_percentile": 407.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 429.81, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 429.81, "10th_percentile": 429.81, "90th_percentile": 429.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1197.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1197.25, "10th_percentile": 1197.25, "90th_percentile": 1197.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 905.12, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 905.12, "10th_percentile": 905.12, "90th_percentile": 905.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 897.94, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 897.94, "10th_percentile": 897.94, "90th_percentile": 897.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1197.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1197.25, "10th_percentile": 1197.25, "90th_percentile": 1197.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1101.47, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1101.47, "10th_percentile": 1101.47, "90th_percentile": 1101.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 538.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 538.76, "10th_percentile": 538.76, "90th_percentile": 538.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 933.86, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 933.86, "10th_percentile": 933.86, "90th_percentile": 933.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 669.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 669.26, "10th_percentile": 669.26, "90th_percentile": 669.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ALBUMIN, HUMAN-KJDA 25 % 25 % IV SOLN", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "RX-217245", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "64208-2512-03", "type": "NDC" } ], "standard_charges": [ { "minimum": 90.26, "maximum": 493.25, "setting": "outpatient", "gross_charge": 493.25, "discounted_cash": 345.27, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 493.25, "10th_percentile": 493.25, "90th_percentile": 493.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 11.5% = $56.72 due to $0.00 Claim Price", "median_amount": 56.72, "10th_percentile": 56.72, "90th_percentile": 56.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 11.5% = $56.72 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 11.5% = $56.72 due to $0.00 Claim Price", "median_amount": 56.72, "10th_percentile": 56.72, "90th_percentile": 56.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 11.5% = $56.72 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 34.03, "90th_percentile": 34.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 34.03, "90th_percentile": 34.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 34.03, "90th_percentile": 34.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 34.03, "90th_percentile": 34.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 34.03, "90th_percentile": 34.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 34.03, "90th_percentile": 34.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.03, "10th_percentile": 34.03, "90th_percentile": 34.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $493.25 @ 6.9% = $34.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 424.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 424.2, "10th_percentile": 424.2, "90th_percentile": 424.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 424.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 424.2, "10th_percentile": 424.2, "90th_percentile": 424.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 424.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 424.2, "10th_percentile": 424.2, "90th_percentile": 424.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 424.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 424.2, "10th_percentile": 424.2, "90th_percentile": 424.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 297.92, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 297.92, "10th_percentile": 297.92, "90th_percentile": 297.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 297.92, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 297.92, "10th_percentile": 297.92, "90th_percentile": 297.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 297.92, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 297.92, "10th_percentile": 297.92, "90th_percentile": 297.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 493.25, "10th_percentile": 493.25, "90th_percentile": 493.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 493.25, "10th_percentile": 493.25, "90th_percentile": 493.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 327.47, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 327.47, "10th_percentile": 327.47, "90th_percentile": 327.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 327.47, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 327.47, "10th_percentile": 327.47, "90th_percentile": 327.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 350.21, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 350.21, "10th_percentile": 350.21, "90th_percentile": 350.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 350.21, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 350.21, "10th_percentile": 350.21, "90th_percentile": 350.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 90.26, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 90.26, "10th_percentile": 90.26, "90th_percentile": 90.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 167.71, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 167.71, "10th_percentile": 167.71, "90th_percentile": 167.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 177.08, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 177.08, "10th_percentile": 177.08, "90th_percentile": 177.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 493.25, "10th_percentile": 493.25, "90th_percentile": 493.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 372.9, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 372.9, "10th_percentile": 372.9, "90th_percentile": 372.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 369.94, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 369.94, "10th_percentile": 369.94, "90th_percentile": 369.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 493.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 493.25, "10th_percentile": 493.25, "90th_percentile": 493.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 453.79, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 453.79, "10th_percentile": 453.79, "90th_percentile": 453.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 221.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 221.96, "10th_percentile": 221.96, "90th_percentile": 221.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 384.74, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 384.74, "10th_percentile": 384.74, "90th_percentile": 384.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 275.73, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 275.73, "10th_percentile": 275.73, "90th_percentile": 275.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG/0.5 ML INH NEBU", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-97580", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "00487-9901-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 6.18, "maximum": 33.75, "setting": "outpatient", "gross_charge": 33.75, "discounted_cash": 23.62, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 33.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 17.79, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.79, "10th_percentile": 17.79, "90th_percentile": 17.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 31.05, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 31.05, "10th_percentile": 31.05, "90th_percentile": 31.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 15.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 15.19, "10th_percentile": 15.19, "90th_percentile": 15.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 25.31, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 25.31, "10th_percentile": 25.31, "90th_percentile": 25.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 26.33, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 26.33, "10th_percentile": 26.33, "90th_percentile": 26.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 33.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 21.94, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 21.94, "10th_percentile": 21.94, "90th_percentile": 21.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 16.94, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.94, "10th_percentile": 16.94, "90th_percentile": 16.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 22.58, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.58, "10th_percentile": 22.58, "90th_percentile": 22.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 33.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 22.75, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 25.35, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.35, "10th_percentile": 25.35, "90th_percentile": 25.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 12.12, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 12.12, "10th_percentile": 12.12, "90th_percentile": 12.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 11.48, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 11.48, "10th_percentile": 11.48, "90th_percentile": 11.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 6.18, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 6.18, "10th_percentile": 6.18, "90th_percentile": 6.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 22.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 22.41, "10th_percentile": 22.41, "90th_percentile": 22.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 25.79, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.79, "10th_percentile": 25.79, "90th_percentile": 25.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 20.76, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.76, "10th_percentile": 20.76, "90th_percentile": 20.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 19.77, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.77, "10th_percentile": 19.77, "90th_percentile": 19.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 19.77, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.77, "10th_percentile": 19.77, "90th_percentile": 19.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 22.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 22.41, "10th_percentile": 22.41, "90th_percentile": 22.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 18.87, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.87, "10th_percentile": 18.87, "90th_percentile": 18.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 25.79, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.79, "10th_percentile": 25.79, "90th_percentile": 25.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 33.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 33.75, "10th_percentile": 33.75, "90th_percentile": 33.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 25.52, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 25.52, "10th_percentile": 25.52, "90th_percentile": 25.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 17.92, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.92, "10th_percentile": 17.92, "90th_percentile": 17.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 29.03, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 29.03, "10th_percentile": 29.03, "90th_percentile": 29.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 29.03, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 29.03, "10th_percentile": 29.03, "90th_percentile": 29.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 29.03, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 29.03, "10th_percentile": 29.03, "90th_percentile": 29.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 29.03, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 29.03, "10th_percentile": 29.03, "90th_percentile": 29.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" } ] } ] }, { "description": "ALPRAZOLAM 0.25 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-324", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60687-0377-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.01, "maximum": 11.0, "setting": "outpatient", "gross_charge": 11.0, "discounted_cash": 7.7, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 9.46, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 9.46, "10th_percentile": 9.46, "90th_percentile": 9.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 9.46, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 9.46, "10th_percentile": 9.46, "90th_percentile": 9.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 9.46, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 9.46, "10th_percentile": 9.46, "90th_percentile": 9.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 9.46, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 9.46, "10th_percentile": 9.46, "90th_percentile": 9.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 6.44, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.44, "10th_percentile": 6.44, "90th_percentile": 6.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 6.44, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.44, "10th_percentile": 6.44, "90th_percentile": 6.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 7.3, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 7.3, "10th_percentile": 7.3, "90th_percentile": 7.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 6.77, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.77, "10th_percentile": 6.77, "90th_percentile": 6.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6.15, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.15, "10th_percentile": 6.15, "90th_percentile": 6.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 8.41, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.41, "10th_percentile": 8.41, "90th_percentile": 8.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 3.95, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 3.95, "10th_percentile": 3.95, "90th_percentile": 3.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.01, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 2.01, "10th_percentile": 2.01, "90th_percentile": 2.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 8.26, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.26, "10th_percentile": 8.26, "90th_percentile": 8.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 7.41, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.41, "10th_percentile": 7.41, "90th_percentile": 7.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 3.74, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 3.74, "10th_percentile": 3.74, "90th_percentile": 3.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 5.84, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.84, "10th_percentile": 5.84, "90th_percentile": 5.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 5.52, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.52, "10th_percentile": 5.52, "90th_percentile": 5.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 7.15, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 7.15, "10th_percentile": 7.15, "90th_percentile": 7.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 4.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 4.95, "10th_percentile": 4.95, "90th_percentile": 4.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 8.25, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 8.58, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 8.58, "10th_percentile": 8.58, "90th_percentile": 8.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 8.32, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 8.32, "10th_percentile": 8.32, "90th_percentile": 8.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 7.3, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 7.3, "10th_percentile": 7.3, "90th_percentile": 7.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 5.8, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.8, "10th_percentile": 5.8, "90th_percentile": 5.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 7.36, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.36, "10th_percentile": 7.36, "90th_percentile": 7.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 10.12, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 10.12, "10th_percentile": 10.12, "90th_percentile": 10.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 8.41, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.41, "10th_percentile": 8.41, "90th_percentile": 8.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ALPRAZOLAM 0.5 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-325", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "65862-0677-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.37, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.17, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.17, "10th_percentile": 1.17, "90th_percentile": 1.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.17, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.17, "10th_percentile": 1.17, "90th_percentile": 1.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.33, "10th_percentile": 1.33, "90th_percentile": 1.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.23, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.23, "10th_percentile": 1.23, "90th_percentile": 1.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.12, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.12, "10th_percentile": 1.12, "90th_percentile": 1.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.53, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.53, "10th_percentile": 1.53, "90th_percentile": 1.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 0.72, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 0.72, "10th_percentile": 0.72, "90th_percentile": 0.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.37, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.37, "10th_percentile": 0.37, "90th_percentile": 0.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1.35, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.35, "10th_percentile": 1.35, "90th_percentile": 1.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 0.68, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1.06, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.06, "10th_percentile": 1.06, "90th_percentile": 1.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1.3, "10th_percentile": 1.3, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1.5, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1.56, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1.56, "10th_percentile": 1.56, "90th_percentile": 1.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1.51, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1.51, "10th_percentile": 1.51, "90th_percentile": 1.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.33, "10th_percentile": 1.33, "90th_percentile": 1.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1.05, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1.34, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.34, "10th_percentile": 1.34, "90th_percentile": 1.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1.84, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1.84, "10th_percentile": 1.84, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.53, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.53, "10th_percentile": 1.53, "90th_percentile": 1.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "AMANTADINE HCL 50 MG/5 ML ORAL SOLN", "drug_information": { "unit": 473.0, "type": "ML" }, "code_information": [ { "code": "RX-365", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00121-0646-16", "type": "NDC" } ], "standard_charges": [ { "minimum": 202.76, "maximum": 1108.0, "setting": "outpatient", "gross_charge": 1108.0, "discounted_cash": 775.6, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 864.24, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 864.24, "10th_percentile": 864.24, "90th_percentile": 864.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 735.6, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 735.6, "10th_percentile": 735.6, "90th_percentile": 735.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 498.6, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 498.6, "10th_percentile": 498.6, "90th_percentile": 498.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 583.92, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 583.92, "10th_percentile": 583.92, "90th_percentile": 583.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 588.35, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 588.35, "10th_percentile": 588.35, "90th_percentile": 588.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1019.36, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1019.36, "10th_percentile": 1019.36, "90th_percentile": 1019.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 741.25, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 741.25, "10th_percentile": 741.25, "90th_percentile": 741.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 837.65, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 837.65, "10th_percentile": 837.65, "90th_percentile": 837.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 831.0, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 831.0, "10th_percentile": 831.0, "90th_percentile": 831.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 846.73, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 846.73, "10th_percentile": 846.73, "90th_percentile": 846.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 556.22, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 556.22, "10th_percentile": 556.22, "90th_percentile": 556.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 720.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 720.2, "10th_percentile": 720.2, "90th_percentile": 720.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1108.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1108.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1108.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 202.76, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 202.76, "10th_percentile": 202.76, "90th_percentile": 202.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 746.79, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 746.79, "10th_percentile": 746.79, "90th_percentile": 746.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 397.77, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 397.77, "10th_percentile": 397.77, "90th_percentile": 397.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 376.72, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 376.72, "10th_percentile": 376.72, "90th_percentile": 376.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 832.11, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 832.11, "10th_percentile": 832.11, "90th_percentile": 832.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 681.53, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 681.53, "10th_percentile": 681.53, "90th_percentile": 681.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 735.6, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 735.6, "10th_percentile": 735.6, "90th_percentile": 735.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1108.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 846.73, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 846.73, "10th_percentile": 846.73, "90th_percentile": 846.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 619.37, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 619.37, "10th_percentile": 619.37, "90th_percentile": 619.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 649.07, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 649.07, "10th_percentile": 649.07, "90th_percentile": 649.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 649.07, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 649.07, "10th_percentile": 649.07, "90th_percentile": 649.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 952.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 952.88, "10th_percentile": 952.88, "90th_percentile": 952.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 952.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 952.88, "10th_percentile": 952.88, "90th_percentile": 952.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 952.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 952.88, "10th_percentile": 952.88, "90th_percentile": 952.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 952.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 952.88, "10th_percentile": 952.88, "90th_percentile": 952.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1108.0, "10th_percentile": 1108.0, "90th_percentile": 1108.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMINO ACID 8 % IN D14W 8-14 % IV SOLP", "drug_information": { "unit": 2000.0, "type": "ML" }, "code_information": [ { "code": "RX-227245", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "00338-0184-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 192.2, "maximum": 1050.25, "setting": "outpatient", "gross_charge": 1050.25, "discounted_cash": 735.17, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 903.22, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 903.22, "10th_percentile": 903.22, "90th_percentile": 903.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 903.22, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 903.22, "10th_percentile": 903.22, "90th_percentile": 903.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 903.22, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 903.22, "10th_percentile": 903.22, "90th_percentile": 903.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 903.22, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 903.22, "10th_percentile": 903.22, "90th_percentile": 903.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 615.24, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 615.24, "10th_percentile": 615.24, "90th_percentile": 615.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 615.24, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 615.24, "10th_percentile": 615.24, "90th_percentile": 615.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 646.01, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 646.01, "10th_percentile": 646.01, "90th_percentile": 646.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 697.26, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 697.26, "10th_percentile": 697.26, "90th_percentile": 697.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1050.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 587.09, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 587.09, "10th_percentile": 587.09, "90th_percentile": 587.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 802.6, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 802.6, "10th_percentile": 802.6, "90th_percentile": 802.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 707.87, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 707.87, "10th_percentile": 707.87, "90th_percentile": 707.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 788.74, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 788.74, "10th_percentile": 788.74, "90th_percentile": 788.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 377.04, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 377.04, "10th_percentile": 377.04, "90th_percentile": 377.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 192.2, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 192.2, "10th_percentile": 192.2, "90th_percentile": 192.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 357.09, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 357.09, "10th_percentile": 357.09, "90th_percentile": 357.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1050.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1050.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1050.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1050.25, "10th_percentile": 1050.25, "90th_percentile": 1050.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 793.99, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 793.99, "10th_percentile": 793.99, "90th_percentile": 793.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 702.62, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 702.62, "10th_percentile": 702.62, "90th_percentile": 702.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 966.23, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 966.23, "10th_percentile": 966.23, "90th_percentile": 966.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 527.23, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 527.23, "10th_percentile": 527.23, "90th_percentile": 527.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 819.2, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 819.2, "10th_percentile": 819.2, "90th_percentile": 819.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 472.61, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 472.61, "10th_percentile": 472.61, "90th_percentile": 472.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 553.48, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 553.48, "10th_percentile": 553.48, "90th_percentile": 553.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 557.68, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 557.68, "10th_percentile": 557.68, "90th_percentile": 557.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 682.66, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 682.66, "10th_percentile": 682.66, "90th_percentile": 682.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 787.69, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 787.69, "10th_percentile": 787.69, "90th_percentile": 787.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 697.26, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 697.26, "10th_percentile": 697.26, "90th_percentile": 697.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 802.6, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 802.6, "10th_percentile": 802.6, "90th_percentile": 802.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "AMINO ACIDS 8 %-LYTES-CA-DEXT 14 % IV SOLP", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "RX-227242", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "00338-0202-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 183.82, "maximum": 1004.5, "setting": "outpatient", "gross_charge": 1004.5, "discounted_cash": 703.15, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 863.87, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 863.87, "10th_percentile": 863.87, "90th_percentile": 863.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 863.87, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 863.87, "10th_percentile": 863.87, "90th_percentile": 863.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 863.87, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 863.87, "10th_percentile": 863.87, "90th_percentile": 863.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 863.87, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 863.87, "10th_percentile": 863.87, "90th_percentile": 863.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 588.44, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 588.44, "10th_percentile": 588.44, "90th_percentile": 588.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 588.44, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 588.44, "10th_percentile": 588.44, "90th_percentile": 588.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 617.87, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 617.87, "10th_percentile": 617.87, "90th_percentile": 617.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 666.89, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 666.89, "10th_percentile": 666.89, "90th_percentile": 666.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1004.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 561.52, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 561.52, "10th_percentile": 561.52, "90th_percentile": 561.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 767.64, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 767.64, "10th_percentile": 767.64, "90th_percentile": 767.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 677.03, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 677.03, "10th_percentile": 677.03, "90th_percentile": 677.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 754.38, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 754.38, "10th_percentile": 754.38, "90th_percentile": 754.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 360.62, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 360.62, "10th_percentile": 360.62, "90th_percentile": 360.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 183.82, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 183.82, "10th_percentile": 183.82, "90th_percentile": 183.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 341.53, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 341.53, "10th_percentile": 341.53, "90th_percentile": 341.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1004.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1004.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1004.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1004.5, "10th_percentile": 1004.5, "90th_percentile": 1004.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 759.4, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 759.4, "10th_percentile": 759.4, "90th_percentile": 759.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 672.01, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 672.01, "10th_percentile": 672.01, "90th_percentile": 672.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 924.14, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 924.14, "10th_percentile": 924.14, "90th_percentile": 924.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 504.26, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 504.26, "10th_percentile": 504.26, "90th_percentile": 504.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 783.51, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 783.51, "10th_percentile": 783.51, "90th_percentile": 783.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 452.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 452.03, "10th_percentile": 452.03, "90th_percentile": 452.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 529.37, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 529.37, "10th_percentile": 529.37, "90th_percentile": 529.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 533.39, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 533.39, "10th_percentile": 533.39, "90th_percentile": 533.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 652.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 652.93, "10th_percentile": 652.93, "90th_percentile": 652.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 753.38, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 753.38, "10th_percentile": 753.38, "90th_percentile": 753.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 666.89, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 666.89, "10th_percentile": 666.89, "90th_percentile": 666.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 767.64, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 767.64, "10th_percentile": 767.64, "90th_percentile": 767.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "AMIODARONE 50 MG/ML IV SOLN", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "RX-9065", "type": "CDM" }, { "code": "J0282", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "63323-0616-03", "type": "NDC" } ], "standard_charges": [ { "minimum": 19.9, "maximum": 108.75, "setting": "outpatient", "gross_charge": 108.75, "discounted_cash": 76.12, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 108.75, "10th_percentile": 108.75, "90th_percentile": 108.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 11.5% = $12.51 due to $0.00 Claim Price", "median_amount": 12.51, "10th_percentile": 12.51, "90th_percentile": 12.51, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 11.5% = $12.51 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 11.5% = $12.51 due to $0.00 Claim Price", "median_amount": 12.51, "10th_percentile": 12.51, "90th_percentile": 12.51, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 11.5% = $12.51 due to $0.00 Claim Price" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.5, "10th_percentile": 7.5, "90th_percentile": 7.5, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $108.75 @ 6.9% = $7.50 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 93.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 93.53, "10th_percentile": 93.53, "90th_percentile": 93.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 93.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 93.53, "10th_percentile": 93.53, "90th_percentile": 93.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 93.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 93.53, "10th_percentile": 93.53, "90th_percentile": 93.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 93.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 93.53, "10th_percentile": 93.53, "90th_percentile": 93.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 65.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.69, "10th_percentile": 65.69, "90th_percentile": 65.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 65.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.69, "10th_percentile": 65.69, "90th_percentile": 65.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 65.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.69, "10th_percentile": 65.69, "90th_percentile": 65.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 108.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 108.75, "10th_percentile": 108.75, "90th_percentile": 108.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 108.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 108.75, "10th_percentile": 108.75, "90th_percentile": 108.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 72.2, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 72.2, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 72.2, "10th_percentile": 72.2, "90th_percentile": 72.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 77.21, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.21, "10th_percentile": 77.21, "90th_percentile": 77.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 77.21, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.21, "10th_percentile": 77.21, "90th_percentile": 77.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 19.9, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 19.9, "10th_percentile": 19.9, "90th_percentile": 19.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 36.98, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 36.98, "10th_percentile": 36.98, "90th_percentile": 36.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 39.04, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 39.04, "10th_percentile": 39.04, "90th_percentile": 39.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 108.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 108.75, "10th_percentile": 108.75, "90th_percentile": 108.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 82.22, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 82.22, "10th_percentile": 82.22, "90th_percentile": 82.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 81.56, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 81.56, "10th_percentile": 81.56, "90th_percentile": 81.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 108.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 108.75, "10th_percentile": 108.75, "90th_percentile": 108.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 100.05, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 100.05, "10th_percentile": 100.05, "90th_percentile": 100.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 48.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 48.94, "10th_percentile": 48.94, "90th_percentile": 48.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 84.83, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 84.83, "10th_percentile": 84.83, "90th_percentile": 84.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 60.79, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.79, "10th_percentile": 60.79, "90th_percentile": 60.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "AMIODARONE IN DEXTROSE,ISO-OSM 150 MG/100 ML (1.5 MG/ML) IV SOLN", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-191197", "type": "CDM" }, { "code": "J0283", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "43066-0150-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 69.04, "maximum": 377.25, "setting": "outpatient", "gross_charge": 377.25, "discounted_cash": 264.07, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 377.25, "10th_percentile": 377.25, "90th_percentile": 377.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 11.5% = $43.38 due to $0.00 Claim Price", "median_amount": 43.38, "10th_percentile": 43.38, "90th_percentile": 43.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 11.5% = $43.38 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 11.5% = $43.38 due to $0.00 Claim Price", "median_amount": 43.38, "10th_percentile": 43.38, "90th_percentile": 43.38, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 11.5% = $43.38 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.03, "10th_percentile": 26.03, "90th_percentile": 26.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.03, "10th_percentile": 26.03, "90th_percentile": 26.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.03, "10th_percentile": 26.03, "90th_percentile": 26.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.03, "10th_percentile": 26.03, "90th_percentile": 26.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.03, "10th_percentile": 26.03, "90th_percentile": 26.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.03, "10th_percentile": 26.03, "90th_percentile": 26.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.03, "10th_percentile": 26.03, "90th_percentile": 26.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.25 @ 6.9% = $26.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 324.44, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 324.44, "10th_percentile": 324.44, "90th_percentile": 324.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 324.44, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 324.44, "10th_percentile": 324.44, "90th_percentile": 324.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 324.44, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 324.44, "10th_percentile": 324.44, "90th_percentile": 324.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 324.44, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 324.44, "10th_percentile": 324.44, "90th_percentile": 324.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 227.86, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 227.86, "10th_percentile": 227.86, "90th_percentile": 227.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 227.86, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 227.86, "10th_percentile": 227.86, "90th_percentile": 227.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 227.86, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 227.86, "10th_percentile": 227.86, "90th_percentile": 227.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 377.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 377.25, "10th_percentile": 377.25, "90th_percentile": 377.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 377.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 377.25, "10th_percentile": 377.25, "90th_percentile": 377.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 250.46, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 250.46, "10th_percentile": 250.46, "90th_percentile": 250.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 250.46, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 250.46, "10th_percentile": 250.46, "90th_percentile": 250.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 267.85, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 267.85, "10th_percentile": 267.85, "90th_percentile": 267.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 267.85, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 267.85, "10th_percentile": 267.85, "90th_percentile": 267.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 69.04, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 69.04, "10th_percentile": 69.04, "90th_percentile": 69.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 128.27, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 128.27, "10th_percentile": 128.27, "90th_percentile": 128.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 135.43, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 135.43, "10th_percentile": 135.43, "90th_percentile": 135.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 377.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 377.25, "10th_percentile": 377.25, "90th_percentile": 377.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 285.2, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 285.2, "10th_percentile": 285.2, "90th_percentile": 285.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 282.94, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 282.94, "10th_percentile": 282.94, "90th_percentile": 282.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 377.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 377.25, "10th_percentile": 377.25, "90th_percentile": 377.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 347.07, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 347.07, "10th_percentile": 347.07, "90th_percentile": 347.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 169.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 169.76, "10th_percentile": 169.76, "90th_percentile": 169.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 294.26, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 294.26, "10th_percentile": 294.26, "90th_percentile": 294.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 210.88, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 210.88, "10th_percentile": 210.88, "90th_percentile": 210.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "AMITRIPTYLINE 10 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-432", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "29300-0419-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.41, "maximum": 2.25, "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1.19, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.19, "10th_percentile": 1.19, "90th_percentile": 1.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1.19, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.19, "10th_percentile": 1.19, "90th_percentile": 1.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.72, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.72, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.32, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.32, "10th_percentile": 1.32, "90th_percentile": 1.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.32, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.32, "10th_percentile": 1.32, "90th_percentile": 1.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.26, "10th_percentile": 1.26, "90th_percentile": 1.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.38, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.38, "10th_percentile": 1.38, "90th_percentile": 1.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.51, "10th_percentile": 1.51, "90th_percentile": 1.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2.07, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2.07, "10th_percentile": 2.07, "90th_percentile": 2.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1.7, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1.7, "10th_percentile": 1.7, "90th_percentile": 1.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1.76, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1.76, "10th_percentile": 1.76, "90th_percentile": 1.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 0.77, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 0.77, "10th_percentile": 0.77, "90th_percentile": 0.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.41, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.41, "10th_percentile": 0.41, "90th_percentile": 0.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.52, "10th_percentile": 1.52, "90th_percentile": 1.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 0.81, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" } ] } ] }, { "description": "AMITRIPTYLINE 10 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-432", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "50268-0037-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.71, "maximum": 20.25, "setting": "outpatient", "gross_charge": 20.25, "discounted_cash": 14.17, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 17.42, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 17.42, "10th_percentile": 17.42, "90th_percentile": 17.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 17.42, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 17.42, "10th_percentile": 17.42, "90th_percentile": 17.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 17.42, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 17.42, "10th_percentile": 17.42, "90th_percentile": 17.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 17.42, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 17.42, "10th_percentile": 17.42, "90th_percentile": 17.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 11.86, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.86, "10th_percentile": 11.86, "90th_percentile": 11.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 11.86, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.86, "10th_percentile": 11.86, "90th_percentile": 11.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 13.44, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 13.44, "10th_percentile": 13.44, "90th_percentile": 13.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 12.46, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.46, "10th_percentile": 12.46, "90th_percentile": 12.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 11.32, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.32, "10th_percentile": 11.32, "90th_percentile": 11.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 15.48, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.48, "10th_percentile": 15.48, "90th_percentile": 15.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 7.27, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 7.27, "10th_percentile": 7.27, "90th_percentile": 7.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.71, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 3.71, "10th_percentile": 3.71, "90th_percentile": 3.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 15.21, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.21, "10th_percentile": 15.21, "90th_percentile": 15.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 13.65, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.65, "10th_percentile": 13.65, "90th_percentile": 13.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 6.89, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 6.89, "10th_percentile": 6.89, "90th_percentile": 6.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 20.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 20.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 20.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 20.25, "10th_percentile": 20.25, "90th_percentile": 20.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 10.75, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.75, "10th_percentile": 10.75, "90th_percentile": 10.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 10.17, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.17, "10th_percentile": 10.17, "90th_percentile": 10.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 13.16, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 13.16, "10th_percentile": 13.16, "90th_percentile": 13.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 9.11, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 9.11, "10th_percentile": 9.11, "90th_percentile": 9.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 15.19, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 15.19, "10th_percentile": 15.19, "90th_percentile": 15.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 15.8, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 15.8, "10th_percentile": 15.8, "90th_percentile": 15.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 15.31, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 15.31, "10th_percentile": 15.31, "90th_percentile": 15.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 13.44, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 13.44, "10th_percentile": 13.44, "90th_percentile": 13.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 10.67, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.67, "10th_percentile": 10.67, "90th_percentile": 10.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 13.55, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.55, "10th_percentile": 13.55, "90th_percentile": 13.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 18.63, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 18.63, "10th_percentile": 18.63, "90th_percentile": 18.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 15.48, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.48, "10th_percentile": 15.48, "90th_percentile": 15.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "AMMONIUM LACTATE 12 % TOP LOTN", "drug_information": { "unit": 225.0, "type": "GR" }, "code_information": [ { "code": "RX-10380", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "45802-0525-55", "type": "NDC" } ], "standard_charges": [ { "minimum": 124.21, "maximum": 678.75, "setting": "outpatient", "gross_charge": 678.75, "discounted_cash": 475.12, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 450.62, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 450.62, "10th_percentile": 450.62, "90th_percentile": 450.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 518.7, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 518.7, "10th_percentile": 518.7, "90th_percentile": 518.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 357.7, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 357.7, "10th_percentile": 357.7, "90th_percentile": 357.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 509.06, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 509.06, "10th_percentile": 509.06, "90th_percentile": 509.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 340.73, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 340.73, "10th_percentile": 340.73, "90th_percentile": 340.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 305.44, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 305.44, "10th_percentile": 305.44, "90th_percentile": 305.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 624.45, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 624.45, "10th_percentile": 624.45, "90th_percentile": 624.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 529.43, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 529.43, "10th_percentile": 529.43, "90th_percentile": 529.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 454.08, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 454.08, "10th_percentile": 454.08, "90th_percentile": 454.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 513.14, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 513.14, "10th_percentile": 513.14, "90th_percentile": 513.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 360.42, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 360.42, "10th_percentile": 360.42, "90th_percentile": 360.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 441.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 441.19, "10th_percentile": 441.19, "90th_percentile": 441.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 678.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 678.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 678.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 509.74, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 509.74, "10th_percentile": 509.74, "90th_percentile": 509.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 243.67, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 243.67, "10th_percentile": 243.67, "90th_percentile": 243.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 230.78, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 230.78, "10th_percentile": 230.78, "90th_percentile": 230.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 124.21, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 124.21, "10th_percentile": 124.21, "90th_percentile": 124.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 457.48, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 457.48, "10th_percentile": 457.48, "90th_percentile": 457.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 450.62, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 450.62, "10th_percentile": 450.62, "90th_percentile": 450.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 417.5, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 417.5, "10th_percentile": 417.5, "90th_percentile": 417.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 678.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 379.42, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 379.42, "10th_percentile": 379.42, "90th_percentile": 379.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 518.7, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 518.7, "10th_percentile": 518.7, "90th_percentile": 518.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 397.61, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 397.61, "10th_percentile": 397.61, "90th_percentile": 397.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 397.61, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 397.61, "10th_percentile": 397.61, "90th_percentile": 397.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 583.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 583.73, "10th_percentile": 583.73, "90th_percentile": 583.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 583.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 583.73, "10th_percentile": 583.73, "90th_percentile": 583.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 583.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 583.73, "10th_percentile": 583.73, "90th_percentile": 583.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 583.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 583.73, "10th_percentile": 583.73, "90th_percentile": 583.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 678.75, "10th_percentile": 678.75, "90th_percentile": 678.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-33227", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "65862-0502-20", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.39, "maximum": 18.5, "setting": "outpatient", "gross_charge": 18.5, "discounted_cash": 12.95, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 15.91, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 15.91, "10th_percentile": 15.91, "90th_percentile": 15.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 15.91, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 15.91, "10th_percentile": 15.91, "90th_percentile": 15.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 15.91, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 15.91, "10th_percentile": 15.91, "90th_percentile": 15.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 15.91, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 15.91, "10th_percentile": 15.91, "90th_percentile": 15.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 10.84, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.84, "10th_percentile": 10.84, "90th_percentile": 10.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 10.84, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.84, "10th_percentile": 10.84, "90th_percentile": 10.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 12.28, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 12.28, "10th_percentile": 12.28, "90th_percentile": 12.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 11.38, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.38, "10th_percentile": 11.38, "90th_percentile": 11.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 10.34, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.34, "10th_percentile": 10.34, "90th_percentile": 10.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 14.14, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.14, "10th_percentile": 14.14, "90th_percentile": 14.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 6.64, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 6.64, "10th_percentile": 6.64, "90th_percentile": 6.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.39, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 3.39, "10th_percentile": 3.39, "90th_percentile": 3.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 13.89, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.89, "10th_percentile": 13.89, "90th_percentile": 13.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 12.47, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.47, "10th_percentile": 12.47, "90th_percentile": 12.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 6.29, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 6.29, "10th_percentile": 6.29, "90th_percentile": 6.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.5, "10th_percentile": 18.5, "90th_percentile": 18.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 9.82, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.82, "10th_percentile": 9.82, "90th_percentile": 9.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 9.29, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.29, "10th_percentile": 9.29, "90th_percentile": 9.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 12.03, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 12.03, "10th_percentile": 12.03, "90th_percentile": 12.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 8.33, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 8.33, "10th_percentile": 8.33, "90th_percentile": 8.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 13.88, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 13.88, "10th_percentile": 13.88, "90th_percentile": 13.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 14.43, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 14.43, "10th_percentile": 14.43, "90th_percentile": 14.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 13.99, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 13.99, "10th_percentile": 13.99, "90th_percentile": 13.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 12.28, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 12.28, "10th_percentile": 12.28, "90th_percentile": 12.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 9.75, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.75, "10th_percentile": 9.75, "90th_percentile": 9.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 12.38, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.38, "10th_percentile": 12.38, "90th_percentile": 12.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 17.02, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 17.02, "10th_percentile": 17.02, "90th_percentile": 17.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 14.14, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.14, "10th_percentile": 14.14, "90th_percentile": 14.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "AMPICILLIN-SULBACTAM 3 G INJ SOLR", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-27283", "type": "CDM" }, { "code": "J0295", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00641-6117-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 27.86, "maximum": 152.25, "setting": "outpatient", "gross_charge": 152.25, "discounted_cash": 106.57, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 152.25, "10th_percentile": 152.25, "90th_percentile": 152.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 11.5% = $17.51 due to $0.00 Claim Price", "median_amount": 17.51, "10th_percentile": 17.51, "90th_percentile": 17.51, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 11.5% = $17.51 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 11.5% = $17.51 due to $0.00 Claim Price", "median_amount": 17.51, "10th_percentile": 17.51, "90th_percentile": 17.51, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 11.5% = $17.51 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.51, "10th_percentile": 10.51, "90th_percentile": 10.51, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.51, "10th_percentile": 10.51, "90th_percentile": 10.51, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.51, "10th_percentile": 10.51, "90th_percentile": 10.51, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.51, "10th_percentile": 10.51, "90th_percentile": 10.51, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.51, "10th_percentile": 10.51, "90th_percentile": 10.51, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.51, "10th_percentile": 10.51, "90th_percentile": 10.51, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.51, "10th_percentile": 10.51, "90th_percentile": 10.51, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $152.25 @ 6.9% = $10.51 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 152.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 152.25, "10th_percentile": 152.25, "90th_percentile": 152.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 85.11, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 85.11, "10th_percentile": 85.11, "90th_percentile": 85.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 115.1, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 115.1, "10th_percentile": 115.1, "90th_percentile": 115.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 68.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 68.51, "10th_percentile": 68.51, "90th_percentile": 68.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 152.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 152.25, "10th_percentile": 152.25, "90th_percentile": 152.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 140.07, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 140.07, "10th_percentile": 140.07, "90th_percentile": 140.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 54.66, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 54.66, "10th_percentile": 54.66, "90th_percentile": 54.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 27.86, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 27.86, "10th_percentile": 27.86, "90th_percentile": 27.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 51.77, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 51.77, "10th_percentile": 51.77, "90th_percentile": 51.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 114.19, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 114.19, "10th_percentile": 114.19, "90th_percentile": 114.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 118.76, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 118.76, "10th_percentile": 118.76, "90th_percentile": 118.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 108.1, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 108.1, "10th_percentile": 108.1, "90th_percentile": 108.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 108.1, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 108.1, "10th_percentile": 108.1, "90th_percentile": 108.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 152.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 152.25, "10th_percentile": 152.25, "90th_percentile": 152.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 152.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 152.25, "10th_percentile": 152.25, "90th_percentile": 152.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 101.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 101.08, "10th_percentile": 101.08, "90th_percentile": 101.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 101.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 101.08, "10th_percentile": 101.08, "90th_percentile": 101.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 91.96, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 91.96, "10th_percentile": 91.96, "90th_percentile": 91.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 91.96, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 91.96, "10th_percentile": 91.96, "90th_percentile": 91.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 91.96, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 91.96, "10th_percentile": 91.96, "90th_percentile": 91.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 130.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 130.94, "10th_percentile": 130.94, "90th_percentile": 130.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 130.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 130.94, "10th_percentile": 130.94, "90th_percentile": 130.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 130.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 130.94, "10th_percentile": 130.94, "90th_percentile": 130.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 130.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 130.94, "10th_percentile": 130.94, "90th_percentile": 130.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" } ] } ] }, { "description": "AMPLATZER PLUG VASC OCCL 6X7MM NIT", "code_information": [ { "code": "SUP-112018", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 929.05, "maximum": 5076.78, "setting": "outpatient", "gross_charge": 5076.78, "discounted_cash": 3553.75, "payers_information": [ { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2269.14, "10th_percentile": 2269.14, "90th_percentile": 2269.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2269.14, "10th_percentile": 2269.14, "90th_percentile": 2269.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2269.14, "10th_percentile": 2269.14, "90th_percentile": 2269.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2269.14, "10th_percentile": 2269.14, "90th_percentile": 2269.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2269.14, "10th_percentile": 2269.14, "90th_percentile": 2269.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2269.14, "10th_percentile": 2269.14, "90th_percentile": 2269.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2269.14, "10th_percentile": 2269.14, "90th_percentile": 2269.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 6.9% = $350.30 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4366.03, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4366.03, "10th_percentile": 4366.03, "90th_percentile": 4366.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4366.03, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4366.03, "10th_percentile": 4366.03, "90th_percentile": 4366.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4366.03, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4366.03, "10th_percentile": 4366.03, "90th_percentile": 4366.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4366.03, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4366.03, "10th_percentile": 4366.03, "90th_percentile": 4366.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3066.38, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3066.38, "10th_percentile": 3066.38, "90th_percentile": 3066.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3066.38, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3066.38, "10th_percentile": 3066.38, "90th_percentile": 3066.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3066.38, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3066.38, "10th_percentile": 3066.38, "90th_percentile": 3066.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 3604.51, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3604.51, "10th_percentile": 3604.51, "90th_percentile": 3604.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 3604.51, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3604.51, "10th_percentile": 3604.51, "90th_percentile": 3604.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 3370.47, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 3370.47, "10th_percentile": 3370.47, "90th_percentile": 3370.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 3370.47, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 3370.47, "10th_percentile": 3370.47, "90th_percentile": 3370.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5076.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5076.78, "10th_percentile": 5076.78, "90th_percentile": 5076.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5076.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5076.78, "10th_percentile": 5076.78, "90th_percentile": 5076.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1822.56, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1822.56, "10th_percentile": 1822.56, "90th_percentile": 1822.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 3812.66, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3812.66, "10th_percentile": 3812.66, "90th_percentile": 3812.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 929.05, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 929.05, "10th_percentile": 929.05, "90th_percentile": 929.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1726.11, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1726.11, "10th_percentile": 1726.11, "90th_percentile": 1726.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 3421.75, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3421.75, "10th_percentile": 3421.75, "90th_percentile": 3421.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 5076.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 5076.78, "10th_percentile": 5076.78, "90th_percentile": 5076.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 3299.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 3299.91, "10th_percentile": 3299.91, "90th_percentile": 3299.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 2695.77, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2695.77, "10th_percentile": 2695.77, "90th_percentile": 2695.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 4670.64, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 4670.64, "10th_percentile": 4670.64, "90th_percentile": 4670.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 3807.59, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 3807.59, "10th_percentile": 3807.59, "90th_percentile": 3807.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 3959.89, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 3959.89, "10th_percentile": 3959.89, "90th_percentile": 3959.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 2284.55, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 2284.55, "10th_percentile": 2284.55, "90th_percentile": 2284.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2837.92, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2837.92, "10th_percentile": 2837.92, "90th_percentile": 2837.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 2675.46, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2675.46, "10th_percentile": 2675.46, "90th_percentile": 2675.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 5076.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 5076.78, "10th_percentile": 5076.78, "90th_percentile": 5076.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 3838.05, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 3838.05, "10th_percentile": 3838.05, "90th_percentile": 3838.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 2548.54, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2548.54, "10th_percentile": 2548.54, "90th_percentile": 2548.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 3396.37, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3396.37, "10th_percentile": 3396.37, "90th_percentile": 3396.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 11.5% = $583.83 due to $0.00 Claim Price", "median_amount": 583.83, "10th_percentile": 583.83, "90th_percentile": 583.83, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 11.5% = $583.83 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 11.5% = $583.83 due to $0.00 Claim Price", "median_amount": 583.83, "10th_percentile": 583.83, "90th_percentile": 583.83, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,076.78 @ 11.5% = $583.83 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5076.78, "10th_percentile": 5076.78, "90th_percentile": 5076.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR KIT TIGHTROPE AR-1588TN-1", "code_information": [ { "code": "SUP-149362", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 322.48, "maximum": 1762.16, "setting": "outpatient", "gross_charge": 1762.16, "discounted_cash": 1233.51, "payers_information": [ { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 6.9% = $121.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 928.66, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3377.8, "10th_percentile": 3377.8, "90th_percentile": 3377.8, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 322.48, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 840.84, "10th_percentile": 840.84, "90th_percentile": 840.84, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1515.46, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1515.46, "10th_percentile": 1515.46, "90th_percentile": 1515.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1515.46, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1515.46, "10th_percentile": 1515.46, "90th_percentile": 1515.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1515.46, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1515.46, "10th_percentile": 1515.46, "90th_percentile": 1515.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1515.46, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1515.46, "10th_percentile": 1515.46, "90th_percentile": 1515.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1064.34, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1064.34, "10th_percentile": 1064.34, "90th_percentile": 1064.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1064.34, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1064.34, "10th_percentile": 1064.34, "90th_percentile": 1064.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1064.34, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1064.34, "10th_percentile": 1064.34, "90th_percentile": 1064.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1169.9, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1169.9, "10th_percentile": 1169.9, "90th_percentile": 1169.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1169.9, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1169.9, "10th_percentile": 1169.9, "90th_percentile": 1169.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1762.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1762.16, "10th_percentile": 1762.16, "90th_percentile": 1762.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1762.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1762.16, "10th_percentile": 1762.16, "90th_percentile": 1762.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 792.97, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 792.97, "10th_percentile": 792.97, "90th_percentile": 792.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1321.62, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1321.62, "10th_percentile": 1321.62, "90th_percentile": 1321.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1762.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1762.16, "10th_percentile": 1762.16, "90th_percentile": 1762.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1332.19, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1332.19, "10th_percentile": 1332.19, "90th_percentile": 1332.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 935.71, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 935.71, "10th_percentile": 935.71, "90th_percentile": 935.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1145.4, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1145.4, "10th_percentile": 1145.4, "90th_percentile": 1145.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1621.19, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1621.19, "10th_percentile": 1621.19, "90th_percentile": 1621.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 985.05, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 985.05, "10th_percentile": 985.05, "90th_percentile": 985.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1762.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1762.16, "10th_percentile": 1762.16, "90th_percentile": 1762.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 884.6, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 884.6, "10th_percentile": 884.6, "90th_percentile": 884.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1374.48, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1374.48, "10th_percentile": 1374.48, "90th_percentile": 1374.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1178.89, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11985.07, "10th_percentile": 11985.07, "90th_percentile": 11985.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 632.62, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 2724.23, "10th_percentile": 2724.23, "90th_percentile": 2724.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1187.7, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1187.7, "10th_percentile": 1187.7, "90th_percentile": 1187.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1323.38, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1323.38, "10th_percentile": 1323.38, "90th_percentile": 1323.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 599.13, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 599.13, "10th_percentile": 599.13, "90th_percentile": 599.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1251.13, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1251.13, "10th_percentile": 1251.13, "90th_percentile": 1251.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1251.13, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1251.13, "10th_percentile": 1251.13, "90th_percentile": 1251.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 11.5% = $202.65 due to $0.00 Claim Price", "median_amount": 202.65, "10th_percentile": 202.65, "90th_percentile": 202.65, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 11.5% = $202.65 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 11.5% = $202.65 due to $0.00 Claim Price", "median_amount": 202.65, "10th_percentile": 202.65, "90th_percentile": 202.65, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,762.16 @ 11.5% = $202.65 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1762.16, "10th_percentile": 1762.16, "90th_percentile": 1762.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR SUTURE 4.75X22MM PEEK DBL LOAD SWIVELOCK", "code_information": [ { "code": "SUP-354770", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 577.65, "maximum": 3156.56, "setting": "outpatient", "gross_charge": 3156.56, "discounted_cash": 2209.59, "payers_information": [ { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.75, "10th_percentile": 770.75, "90th_percentile": 770.75, "count": "23", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 6.9% = $217.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1663.51, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3377.8, "10th_percentile": 3377.8, "90th_percentile": 3377.8, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 577.65, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 840.84, "10th_percentile": 840.84, "90th_percentile": 840.84, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2714.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2714.64, "10th_percentile": 2714.64, "90th_percentile": 2714.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2714.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2714.64, "10th_percentile": 2714.64, "90th_percentile": 2714.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2714.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2714.64, "10th_percentile": 2714.64, "90th_percentile": 2714.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2714.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2714.64, "10th_percentile": 2714.64, "90th_percentile": 2714.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1906.56, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1906.56, "10th_percentile": 1906.56, "90th_percentile": 1906.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1906.56, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1906.56, "10th_percentile": 1906.56, "90th_percentile": 1906.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1906.56, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1906.56, "10th_percentile": 1906.56, "90th_percentile": 1906.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2095.64, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2095.64, "10th_percentile": 2095.64, "90th_percentile": 2095.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2095.64, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2095.64, "10th_percentile": 2095.64, "90th_percentile": 2095.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3156.56, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3156.56, "10th_percentile": 3156.56, "90th_percentile": 3156.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3156.56, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3156.56, "10th_percentile": 3156.56, "90th_percentile": 3156.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1420.45, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1420.45, "10th_percentile": 1420.45, "90th_percentile": 1420.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2367.42, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2367.42, "10th_percentile": 2367.42, "90th_percentile": 2367.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 3156.56, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 3156.56, "10th_percentile": 3156.56, "90th_percentile": 3156.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2386.36, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2386.36, "10th_percentile": 2386.36, "90th_percentile": 2386.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1676.13, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1676.13, "10th_percentile": 1676.13, "90th_percentile": 1676.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 2051.76, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 2051.76, "10th_percentile": 2051.76, "90th_percentile": 2051.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2904.04, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2904.04, "10th_percentile": 2904.04, "90th_percentile": 2904.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1764.52, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1764.52, "10th_percentile": 1764.52, "90th_percentile": 1764.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3156.56, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3156.56, "10th_percentile": 3156.56, "90th_percentile": 3156.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1584.59, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1584.59, "10th_percentile": 1584.59, "90th_percentile": 1584.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 2462.12, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 2462.12, "10th_percentile": 2462.12, "90th_percentile": 2462.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 2111.74, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11985.07, "10th_percentile": 11985.07, "90th_percentile": 11985.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1133.21, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 2724.23, "10th_percentile": 2724.23, "90th_percentile": 2724.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 2127.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2127.52, "10th_percentile": 2127.52, "90th_percentile": 2127.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 2370.58, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2370.58, "10th_percentile": 2370.58, "90th_percentile": 2370.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1073.23, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1073.23, "10th_percentile": 1073.23, "90th_percentile": 1073.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2241.16, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2241.16, "10th_percentile": 2241.16, "90th_percentile": 2241.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2241.16, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2241.16, "10th_percentile": 2241.16, "90th_percentile": 2241.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 11.5% = $363.00 due to $0.00 Claim Price", "median_amount": 363.0, "10th_percentile": 363.0, "90th_percentile": 363.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 11.5% = $363.00 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 11.5% = $363.00 due to $0.00 Claim Price", "median_amount": 363.0, "10th_percentile": 363.0, "90th_percentile": 363.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,156.56 @ 11.5% = $363.00 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3156.56, "10th_percentile": 3156.56, "90th_percentile": 3156.56, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANGIOPLASTY PACK LARGE BORE", "code_information": [ { "code": "SUP-11249", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 16.33, "maximum": 89.26, "setting": "outpatient", "gross_charge": 89.26, "discounted_cash": 62.48, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 76.76, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 76.76, "10th_percentile": 76.76, "90th_percentile": 76.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 76.76, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 76.76, "10th_percentile": 76.76, "90th_percentile": 76.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 76.76, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 76.76, "10th_percentile": 76.76, "90th_percentile": 76.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 76.76, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 76.76, "10th_percentile": 76.76, "90th_percentile": 76.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 54.9, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.9, "10th_percentile": 54.9, "90th_percentile": 54.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 68.21, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.21, "10th_percentile": 68.21, "90th_percentile": 68.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 49.9, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.9, "10th_percentile": 49.9, "90th_percentile": 49.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 89.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 59.26, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 59.26, "10th_percentile": 59.26, "90th_percentile": 59.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 52.29, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 52.29, "10th_percentile": 52.29, "90th_percentile": 52.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 52.29, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 52.29, "10th_percentile": 52.29, "90th_percentile": 52.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 16.33, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 16.33, "10th_percentile": 16.33, "90th_percentile": 16.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 32.04, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 32.04, "10th_percentile": 32.04, "90th_percentile": 32.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 60.16, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.16, "10th_percentile": 60.16, "90th_percentile": 60.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 30.35, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 30.35, "10th_percentile": 30.35, "90th_percentile": 30.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 67.03, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.03, "10th_percentile": 67.03, "90th_percentile": 67.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 89.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 89.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 89.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 59.71, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.71, "10th_percentile": 59.71, "90th_percentile": 59.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 82.12, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 82.12, "10th_percentile": 82.12, "90th_percentile": 82.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 47.04, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 47.04, "10th_percentile": 47.04, "90th_percentile": 47.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 47.4, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 47.4, "10th_percentile": 47.4, "90th_percentile": 47.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 69.62, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 69.62, "10th_percentile": 69.62, "90th_percentile": 69.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 40.17, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 40.17, "10th_percentile": 40.17, "90th_percentile": 40.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 59.26, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 59.26, "10th_percentile": 59.26, "90th_percentile": 59.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 66.95, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 66.95, "10th_percentile": 66.95, "90th_percentile": 66.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 68.21, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.21, "10th_percentile": 68.21, "90th_percentile": 68.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 58.02, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 58.02, "10th_percentile": 58.02, "90th_percentile": 58.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 44.81, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.81, "10th_percentile": 44.81, "90th_percentile": 44.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 67.48, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 67.48, "10th_percentile": 67.48, "90th_percentile": 67.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 89.26, "10th_percentile": 89.26, "90th_percentile": 89.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 7800.29, "maximum": 21457.4, "setting": "inpatient", "gross_charge": 80362.26, "discounted_cash": 56253.58, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 69111.58, "10th_percentile": 69111.58, "90th_percentile": 69111.58, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 69111.58, "10th_percentile": 69111.58, "90th_percentile": 69111.58, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 69111.58, "10th_percentile": 69111.58, "90th_percentile": 69111.58, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 69111.58, "10th_percentile": 69111.58, "90th_percentile": 69111.58, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services; 100% Billed", "median_amount": 80362.26, "10th_percentile": 80362.26, "90th_percentile": 80362.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services; 100% Billed", "median_amount": 80362.26, "10th_percentile": 80362.26, "90th_percentile": 80362.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 80362.26, "10th_percentile": 80362.26, "90th_percentile": 80362.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services - OON; 100% Billed", "median_amount": 80362.26, "10th_percentile": 80362.26, "90th_percentile": 80362.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_percentage": 38.9, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; ALL INPATIENT; 38.9% Billed", "median_amount": 31260.92, "10th_percentile": 31260.92, "90th_percentile": 31260.92, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_percentage": 35.6, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All Inpatient Services; 35.6% Billed", "median_amount": 28608.96, "10th_percentile": 28608.96, "90th_percentile": 28608.96, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_percentage": 18.3, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 14706.31, "10th_percentile": 14706.31, "90th_percentile": 14706.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 36163.06, "10th_percentile": 36163.06, "90th_percentile": 36163.06, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_percentage": 92.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 73933.28, "10th_percentile": 73933.28, "90th_percentile": 73933.28, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_percentage": 76.1, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; Inpatient; 76.1% Billed", "median_amount": 61155.68, "10th_percentile": 61155.68, "90th_percentile": 61155.68, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; IP Services. ADP RATE (for patient estimates only); 49% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39377.51, "10th_percentile": 39377.51, "90th_percentile": 39377.51, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; Inpatient Services; 75% Billed", "median_amount": 60271.7, "10th_percentile": 60271.7, "90th_percentile": 60271.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_percentage": 78.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 62682.6, "10th_percentile": 62682.6, "90th_percentile": 62682.6, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_dollar": 7800.29, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.12, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $9,097.13; Total: $9,097.13 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9097.13, "10th_percentile": 9097.13, "90th_percentile": 9097.13, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.12, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $9,097.13; Total: $9,097.13 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 7800.29, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.12, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $9,097.13; Total: $9,097.13", "median_amount": 9097.13, "10th_percentile": 9097.13, "90th_percentile": 9097.13, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.12, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $9,097.13; Total: $9,097.13" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 7800.29, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.12, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $9,097.13; Total: $9,097.13", "median_amount": 9097.13, "10th_percentile": 9097.13, "90th_percentile": 9097.13, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.12, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $9,097.13; Total: $9,097.13" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 17122.42, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24995.47, "10th_percentile": 24995.47, "90th_percentile": 24995.47, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 21457.4, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30186.83, "10th_percentile": 30186.83, "90th_percentile": 30186.83, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 14900.56, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 13,017.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE PREF STOP LOSS & LESSOR OF 9.*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25983.49, "10th_percentile": 25983.49, "90th_percentile": 25983.49, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 17122.42, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24995.47, "10th_percentile": 24995.47, "90th_percentile": 24995.47, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 14190.85, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 12,397.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE SELECT STOP LOSS & LESSOR OF *; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24757.49, "10th_percentile": 24757.49, "90th_percentile": 24757.49, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 21457.4, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30186.83, "10th_percentile": 30186.83, "90th_percentile": 30186.83, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 15893.01, "standard_charge_algorithm": "Re-evaluated: HLB.839670590; Using new claim; Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 13,884.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27751.59, "10th_percentile": 27751.59, "90th_percentile": 27751.59, "count": "1 through 10", "methodology": "case rate" } ] } ] }, { "description": "ARGATROBAN 100 MG/ML IV SOLN", "drug_information": { "unit": 2.5, "type": "ML" }, "code_information": [ { "code": "RX-28947", "type": "CDM" }, { "code": "J0883", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00143-9674-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 264.94, "maximum": 1447.75, "setting": "outpatient", "gross_charge": 1447.75, "discounted_cash": 1013.42, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1447.75, "10th_percentile": 1447.75, "90th_percentile": 1447.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 11.5% = $166.49 due to $0.00 Claim Price", "median_amount": 166.49, "10th_percentile": 166.49, "90th_percentile": 166.49, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 11.5% = $166.49 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 11.5% = $166.49 due to $0.00 Claim Price", "median_amount": 166.49, "10th_percentile": 166.49, "90th_percentile": 166.49, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 11.5% = $166.49 due to $0.00 Claim Price" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.89, "10th_percentile": 99.89, "90th_percentile": 99.89, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.89, "10th_percentile": 99.89, "90th_percentile": 99.89, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.89, "10th_percentile": 99.89, "90th_percentile": 99.89, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.89, "10th_percentile": 99.89, "90th_percentile": 99.89, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.89, "10th_percentile": 99.89, "90th_percentile": 99.89, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.89, "10th_percentile": 99.89, "90th_percentile": 99.89, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.89, "10th_percentile": 99.89, "90th_percentile": 99.89, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,447.75 @ 6.9% = $99.89 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1245.07, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1245.07, "10th_percentile": 1245.07, "90th_percentile": 1245.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1245.07, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1245.07, "10th_percentile": 1245.07, "90th_percentile": 1245.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1245.07, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1245.07, "10th_percentile": 1245.07, "90th_percentile": 1245.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1245.07, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1245.07, "10th_percentile": 1245.07, "90th_percentile": 1245.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 874.44, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 874.44, "10th_percentile": 874.44, "90th_percentile": 874.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 874.44, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 874.44, "10th_percentile": 874.44, "90th_percentile": 874.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 874.44, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 874.44, "10th_percentile": 874.44, "90th_percentile": 874.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1447.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1447.75, "10th_percentile": 1447.75, "90th_percentile": 1447.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1447.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1447.75, "10th_percentile": 1447.75, "90th_percentile": 1447.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 961.16, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 961.16, "10th_percentile": 961.16, "90th_percentile": 961.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 961.16, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 961.16, "10th_percentile": 961.16, "90th_percentile": 961.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1027.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1027.9, "10th_percentile": 1027.9, "90th_percentile": 1027.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1027.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1027.9, "10th_percentile": 1027.9, "90th_percentile": 1027.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 264.94, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 264.94, "10th_percentile": 264.94, "90th_percentile": 264.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 492.24, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 492.24, "10th_percentile": 492.24, "90th_percentile": 492.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 519.74, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 519.74, "10th_percentile": 519.74, "90th_percentile": 519.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1447.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1447.75, "10th_percentile": 1447.75, "90th_percentile": 1447.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1094.5, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1094.5, "10th_percentile": 1094.5, "90th_percentile": 1094.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1085.81, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1085.81, "10th_percentile": 1085.81, "90th_percentile": 1085.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1447.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1447.75, "10th_percentile": 1447.75, "90th_percentile": 1447.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1331.93, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1331.93, "10th_percentile": 1331.93, "90th_percentile": 1331.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 651.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 651.49, "10th_percentile": 651.49, "90th_percentile": 651.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1129.25, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1129.25, "10th_percentile": 1129.25, "90th_percentile": 1129.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 809.29, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 809.29, "10th_percentile": 809.29, "90th_percentile": 809.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ARIPIPRAZOLE 2 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-70306", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "43598-0554-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.7, "maximum": 14.75, "setting": "outpatient", "gross_charge": 14.75, "discounted_cash": 10.32, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12.69, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12.69, "10th_percentile": 12.69, "90th_percentile": 12.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12.69, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12.69, "10th_percentile": 12.69, "90th_percentile": 12.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12.69, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12.69, "10th_percentile": 12.69, "90th_percentile": 12.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12.69, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12.69, "10th_percentile": 12.69, "90th_percentile": 12.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8.64, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.64, "10th_percentile": 8.64, "90th_percentile": 8.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8.64, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.64, "10th_percentile": 8.64, "90th_percentile": 8.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9.79, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9.79, "10th_percentile": 9.79, "90th_percentile": 9.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 9.07, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.07, "10th_percentile": 9.07, "90th_percentile": 9.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 8.25, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 11.27, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.27, "10th_percentile": 11.27, "90th_percentile": 11.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 5.3, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 5.3, "10th_percentile": 5.3, "90th_percentile": 5.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.7, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 2.7, "10th_percentile": 2.7, "90th_percentile": 2.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 11.08, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.08, "10th_percentile": 11.08, "90th_percentile": 11.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 9.94, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.94, "10th_percentile": 9.94, "90th_percentile": 9.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 5.02, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 5.02, "10th_percentile": 5.02, "90th_percentile": 5.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 7.83, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.83, "10th_percentile": 7.83, "90th_percentile": 7.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 7.4, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.4, "10th_percentile": 7.4, "90th_percentile": 7.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 9.59, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 9.59, "10th_percentile": 9.59, "90th_percentile": 9.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 6.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 6.64, "10th_percentile": 6.64, "90th_percentile": 6.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 11.06, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 11.06, "10th_percentile": 11.06, "90th_percentile": 11.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 11.51, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 11.51, "10th_percentile": 11.51, "90th_percentile": 11.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 11.15, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 11.15, "10th_percentile": 11.15, "90th_percentile": 11.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9.79, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9.79, "10th_percentile": 9.79, "90th_percentile": 9.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 7.77, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.77, "10th_percentile": 7.77, "90th_percentile": 7.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 9.87, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.87, "10th_percentile": 9.87, "90th_percentile": 9.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 13.57, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 13.57, "10th_percentile": 13.57, "90th_percentile": 13.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 11.27, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.27, "10th_percentile": 11.27, "90th_percentile": 11.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ARIPIPRAZOLE 2 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-70306", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "50268-0087-12", "type": "NDC" } ], "standard_charges": [ { "minimum": 6.5, "maximum": 35.5, "setting": "outpatient", "gross_charge": 35.5, "discounted_cash": 24.85, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 30.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 30.53, "10th_percentile": 30.53, "90th_percentile": 30.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 30.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 30.53, "10th_percentile": 30.53, "90th_percentile": 30.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 30.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 30.53, "10th_percentile": 30.53, "90th_percentile": 30.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 30.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 30.53, "10th_percentile": 30.53, "90th_percentile": 30.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 20.8, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.8, "10th_percentile": 20.8, "90th_percentile": 20.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 20.8, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.8, "10th_percentile": 20.8, "90th_percentile": 20.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 23.57, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 23.57, "10th_percentile": 23.57, "90th_percentile": 23.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 35.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 21.84, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.84, "10th_percentile": 21.84, "90th_percentile": 21.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 19.84, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.84, "10th_percentile": 19.84, "90th_percentile": 19.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 27.13, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.13, "10th_percentile": 27.13, "90th_percentile": 27.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 12.74, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 12.74, "10th_percentile": 12.74, "90th_percentile": 12.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 6.5, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 26.66, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.66, "10th_percentile": 26.66, "90th_percentile": 26.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 23.93, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.93, "10th_percentile": 23.93, "90th_percentile": 23.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 12.07, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 12.07, "10th_percentile": 12.07, "90th_percentile": 12.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 35.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 35.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 35.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.5, "10th_percentile": 35.5, "90th_percentile": 35.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 18.85, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.85, "10th_percentile": 18.85, "90th_percentile": 18.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 17.82, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 23.08, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 23.08, "10th_percentile": 23.08, "90th_percentile": 23.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 15.98, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 15.98, "10th_percentile": 15.98, "90th_percentile": 15.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 26.63, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 26.63, "10th_percentile": 26.63, "90th_percentile": 26.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 27.69, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 27.69, "10th_percentile": 27.69, "90th_percentile": 27.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 26.84, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 26.84, "10th_percentile": 26.84, "90th_percentile": 26.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 23.57, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 23.57, "10th_percentile": 23.57, "90th_percentile": 23.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 18.71, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.71, "10th_percentile": 18.71, "90th_percentile": 18.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 23.75, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.75, "10th_percentile": 23.75, "90th_percentile": 23.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 32.66, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 32.66, "10th_percentile": 32.66, "90th_percentile": 32.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 27.13, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.13, "10th_percentile": 27.13, "90th_percentile": 27.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ARTERIAL LINE TRANSDUCER SINGLE", "code_information": [ { "code": "SUP-303387", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 14.7, "maximum": 80.34, "setting": "outpatient", "gross_charge": 80.34, "discounted_cash": 56.24, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 69.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 69.09, "10th_percentile": 69.09, "90th_percentile": 69.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 69.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 69.09, "10th_percentile": 69.09, "90th_percentile": 69.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 69.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 69.09, "10th_percentile": 69.09, "90th_percentile": 69.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 69.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 69.09, "10th_percentile": 69.09, "90th_percentile": 69.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 49.42, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.42, "10th_percentile": 49.42, "90th_percentile": 49.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 61.4, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.4, "10th_percentile": 61.4, "90th_percentile": 61.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 44.91, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.91, "10th_percentile": 44.91, "90th_percentile": 44.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 80.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 53.34, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 53.34, "10th_percentile": 53.34, "90th_percentile": 53.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 47.06, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 47.06, "10th_percentile": 47.06, "90th_percentile": 47.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 47.06, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 47.06, "10th_percentile": 47.06, "90th_percentile": 47.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 14.7, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 14.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 28.84, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 28.84, "10th_percentile": 28.84, "90th_percentile": 28.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 54.15, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.15, "10th_percentile": 54.15, "90th_percentile": 54.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 27.32, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 27.32, "10th_percentile": 27.32, "90th_percentile": 27.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 60.34, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.34, "10th_percentile": 60.34, "90th_percentile": 60.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 80.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 80.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 80.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 53.75, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.75, "10th_percentile": 53.75, "90th_percentile": 53.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 73.91, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 73.91, "10th_percentile": 73.91, "90th_percentile": 73.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 42.34, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 42.34, "10th_percentile": 42.34, "90th_percentile": 42.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 42.66, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 42.66, "10th_percentile": 42.66, "90th_percentile": 42.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 62.67, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 62.67, "10th_percentile": 62.67, "90th_percentile": 62.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 36.15, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 36.15, "10th_percentile": 36.15, "90th_percentile": 36.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 53.34, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 53.34, "10th_percentile": 53.34, "90th_percentile": 53.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 60.26, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 60.26, "10th_percentile": 60.26, "90th_percentile": 60.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 61.4, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.4, "10th_percentile": 61.4, "90th_percentile": 61.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 52.22, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 52.22, "10th_percentile": 52.22, "90th_percentile": 52.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 40.33, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.33, "10th_percentile": 40.33, "90th_percentile": 40.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 60.74, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 60.74, "10th_percentile": 60.74, "90th_percentile": 60.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 80.34, "10th_percentile": 80.34, "90th_percentile": 80.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARTHREX PASSPORT BUTTON CANNULA ARTHSCP 10MMX4CM AR-6592-10-40", "code_information": [ { "code": "SUP-135669", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 78.63, "maximum": 429.65, "setting": "outpatient", "gross_charge": 429.65, "discounted_cash": 300.75, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 369.5, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 369.5, "10th_percentile": 369.5, "90th_percentile": 369.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 369.5, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 369.5, "10th_percentile": 369.5, "90th_percentile": 369.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 369.5, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 369.5, "10th_percentile": 369.5, "90th_percentile": 369.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 369.5, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 369.5, "10th_percentile": 369.5, "90th_percentile": 369.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 264.28, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 264.28, "10th_percentile": 264.28, "90th_percentile": 264.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 328.34, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 328.34, "10th_percentile": 328.34, "90th_percentile": 328.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 240.17, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 240.17, "10th_percentile": 240.17, "90th_percentile": 240.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 429.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 285.24, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 285.24, "10th_percentile": 285.24, "90th_percentile": 285.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 251.69, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 251.69, "10th_percentile": 251.69, "90th_percentile": 251.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 251.69, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 251.69, "10th_percentile": 251.69, "90th_percentile": 251.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 78.63, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 78.63, "10th_percentile": 78.63, "90th_percentile": 78.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 154.24, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 154.24, "10th_percentile": 154.24, "90th_percentile": 154.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 289.58, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 289.58, "10th_percentile": 289.58, "90th_percentile": 289.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 146.08, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 146.08, "10th_percentile": 146.08, "90th_percentile": 146.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 322.67, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 322.67, "10th_percentile": 322.67, "90th_percentile": 322.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 429.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 429.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 429.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 287.44, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 287.44, "10th_percentile": 287.44, "90th_percentile": 287.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 395.28, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 395.28, "10th_percentile": 395.28, "90th_percentile": 395.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 226.43, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.43, "10th_percentile": 226.43, "90th_percentile": 226.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 228.14, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 228.14, "10th_percentile": 228.14, "90th_percentile": 228.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 335.13, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 335.13, "10th_percentile": 335.13, "90th_percentile": 335.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 193.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 193.34, "10th_percentile": 193.34, "90th_percentile": 193.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 285.24, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 285.24, "10th_percentile": 285.24, "90th_percentile": 285.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 322.24, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 322.24, "10th_percentile": 322.24, "90th_percentile": 322.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 328.34, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 328.34, "10th_percentile": 328.34, "90th_percentile": 328.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 279.27, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 279.27, "10th_percentile": 279.27, "90th_percentile": 279.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 215.68, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 215.68, "10th_percentile": 215.68, "90th_percentile": 215.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 324.82, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 324.82, "10th_percentile": 324.82, "90th_percentile": 324.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 429.65, "10th_percentile": 429.65, "90th_percentile": 429.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARTICULATION KT TOT ELB NEXEL SZ 4", "code_information": [ { "code": "SUP-159473", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 774.9, "maximum": 4234.43, "setting": "outpatient", "gross_charge": 4234.43, "discounted_cash": 2964.1, "payers_information": [ { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 6.9% = $292.18 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3641.61, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3641.61, "10th_percentile": 3641.61, "90th_percentile": 3641.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3641.61, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3641.61, "10th_percentile": 3641.61, "90th_percentile": 3641.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3641.61, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3641.61, "10th_percentile": 3641.61, "90th_percentile": 3641.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3641.61, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3641.61, "10th_percentile": 3641.61, "90th_percentile": 3641.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2557.6, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2557.6, "10th_percentile": 2557.6, "90th_percentile": 2557.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2557.6, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2557.6, "10th_percentile": 2557.6, "90th_percentile": 2557.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2557.6, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2557.6, "10th_percentile": 2557.6, "90th_percentile": 2557.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2811.24, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2811.24, "10th_percentile": 2811.24, "90th_percentile": 2811.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2811.24, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2811.24, "10th_percentile": 2811.24, "90th_percentile": 2811.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4234.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4234.43, "10th_percentile": 4234.43, "90th_percentile": 4234.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4234.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4234.43, "10th_percentile": 4234.43, "90th_percentile": 4234.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 3006.45, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3006.45, "10th_percentile": 3006.45, "90th_percentile": 3006.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 3006.45, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3006.45, "10th_percentile": 3006.45, "90th_percentile": 3006.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 3180.06, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3180.06, "10th_percentile": 3180.06, "90th_percentile": 3180.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 774.9, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 774.9, "10th_percentile": 774.9, "90th_percentile": 774.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1520.16, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1520.16, "10th_percentile": 1520.16, "90th_percentile": 1520.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 2854.01, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2854.01, "10th_percentile": 2854.01, "90th_percentile": 2854.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1439.71, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1439.71, "10th_percentile": 1439.71, "90th_percentile": 1439.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 2231.54, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3408.23, "10th_percentile": 3408.23, "90th_percentile": 3408.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 2752.38, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 2752.38, "10th_percentile": 2752.38, "90th_percentile": 2752.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 2248.48, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2248.48, "10th_percentile": 2248.48, "90th_percentile": 2248.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 2832.83, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2832.83, "10th_percentile": 2832.83, "90th_percentile": 2832.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4234.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4234.43, "10th_percentile": 4234.43, "90th_percentile": 4234.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 2125.68, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2125.68, "10th_percentile": 2125.68, "90th_percentile": 2125.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 3895.68, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 3895.68, "10th_percentile": 3895.68, "90th_percentile": 3895.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 3201.23, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 3201.23, "10th_percentile": 3201.23, "90th_percentile": 3201.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2367.05, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2367.05, "10th_percentile": 2367.05, "90th_percentile": 2367.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 4234.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 4234.43, "10th_percentile": 4234.43, "90th_percentile": 4234.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 3175.82, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 3175.82, "10th_percentile": 3175.82, "90th_percentile": 3175.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1905.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1905.49, "10th_percentile": 1905.49, "90th_percentile": 1905.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 3302.86, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 3302.86, "10th_percentile": 3302.86, "90th_percentile": 3302.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 11.5% = $486.96 due to $0.00 Claim Price", "median_amount": 486.96, "10th_percentile": 486.96, "90th_percentile": 486.96, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 11.5% = $486.96 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 11.5% = $486.96 due to $0.00 Claim Price", "median_amount": 486.96, "10th_percentile": 486.96, "90th_percentile": 486.96, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,234.43 @ 11.5% = $486.96 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4234.43, "10th_percentile": 4234.43, "90th_percentile": 4234.43, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ASPIRIN 81 MG ORAL CHEW", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-680", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "00536-1008-36", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.41, "maximum": 2.25, "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.52, "10th_percentile": 1.52, "90th_percentile": 1.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 0.81, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 0.77, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 0.77, "10th_percentile": 0.77, "90th_percentile": 0.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.41, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.41, "10th_percentile": 0.41, "90th_percentile": 0.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.26, "10th_percentile": 1.26, "90th_percentile": 1.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1.7, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1.7, "10th_percentile": 1.7, "90th_percentile": 1.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2.07, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2.07, "10th_percentile": 2.07, "90th_percentile": 2.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1.76, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1.76, "10th_percentile": 1.76, "90th_percentile": 1.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.51, "10th_percentile": 1.51, "90th_percentile": 1.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.6, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.6, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.36, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.36, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.36, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price", "median_amount": 0.26, "10th_percentile": 0.26, "90th_percentile": 0.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price", "median_amount": 0.26, "10th_percentile": 0.26, "90th_percentile": 0.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "ATENOLOL 25 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-717", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "60687-0605-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.56, "maximum": 8.5, "setting": "outpatient", "gross_charge": 8.5, "discounted_cash": 5.95, "payers_information": [ { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 5.53, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 5.53, "10th_percentile": 5.53, "90th_percentile": 5.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 6.38, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 3.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 3.83, "10th_percentile": 3.83, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 4.27, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.27, "10th_percentile": 4.27, "90th_percentile": 4.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 7.82, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 7.82, "10th_percentile": 7.82, "90th_percentile": 7.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 6.63, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 6.63, "10th_percentile": 6.63, "90th_percentile": 6.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 5.69, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.69, "10th_percentile": 5.69, "90th_percentile": 5.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.75, "10th_percentile": 4.75, "90th_percentile": 4.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 6.43, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 6.43, "10th_percentile": 6.43, "90th_percentile": 6.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.56, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1.56, "10th_percentile": 1.56, "90th_percentile": 1.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 2.89, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 2.89, "10th_percentile": 2.89, "90th_percentile": 2.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 3.05, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 3.05, "10th_percentile": 3.05, "90th_percentile": 3.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 6.38, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 5.73, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.73, "10th_percentile": 5.73, "90th_percentile": 5.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5.64, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5.64, "10th_percentile": 5.64, "90th_percentile": 5.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5.64, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5.64, "10th_percentile": 5.64, "90th_percentile": 5.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 6.04, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.04, "10th_percentile": 6.04, "90th_percentile": 6.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 6.04, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.04, "10th_percentile": 6.04, "90th_percentile": 6.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 5.13, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.13, "10th_percentile": 5.13, "90th_percentile": 5.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 5.13, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.13, "10th_percentile": 5.13, "90th_percentile": 5.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5.13, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.13, "10th_percentile": 5.13, "90th_percentile": 5.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.31, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.31, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.31, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.31, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 11.5% = $0.98 due to $0.00 Claim Price", "median_amount": 0.98, "10th_percentile": 0.98, "90th_percentile": 0.98, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 11.5% = $0.98 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 11.5% = $0.98 due to $0.00 Claim Price", "median_amount": 0.98, "10th_percentile": 0.98, "90th_percentile": 0.98, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 11.5% = $0.98 due to $0.00 Claim Price" } ] } ] }, { "description": "ATENOLOL 25 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-717", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "60687-0605-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.56, "maximum": 8.5, "setting": "outpatient", "gross_charge": 8.5, "discounted_cash": 5.95, "payers_information": [ { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 5.53, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 5.53, "10th_percentile": 5.53, "90th_percentile": 5.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 6.38, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 3.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 3.83, "10th_percentile": 3.83, "90th_percentile": 3.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 4.27, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.27, "10th_percentile": 4.27, "90th_percentile": 4.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 7.82, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 7.82, "10th_percentile": 7.82, "90th_percentile": 7.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 6.63, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 6.63, "10th_percentile": 6.63, "90th_percentile": 6.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 5.69, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.69, "10th_percentile": 5.69, "90th_percentile": 5.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.75, "10th_percentile": 4.75, "90th_percentile": 4.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 6.43, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 6.43, "10th_percentile": 6.43, "90th_percentile": 6.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.56, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1.56, "10th_percentile": 1.56, "90th_percentile": 1.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 2.89, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 2.89, "10th_percentile": 2.89, "90th_percentile": 2.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 3.05, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 3.05, "10th_percentile": 3.05, "90th_percentile": 3.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 6.38, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 5.73, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.73, "10th_percentile": 5.73, "90th_percentile": 5.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5.64, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5.64, "10th_percentile": 5.64, "90th_percentile": 5.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5.64, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5.64, "10th_percentile": 5.64, "90th_percentile": 5.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 6.04, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.04, "10th_percentile": 6.04, "90th_percentile": 6.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 6.04, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.04, "10th_percentile": 6.04, "90th_percentile": 6.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 5.13, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.13, "10th_percentile": 5.13, "90th_percentile": 5.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 5.13, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.13, "10th_percentile": 5.13, "90th_percentile": 5.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5.13, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.13, "10th_percentile": 5.13, "90th_percentile": 5.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.31, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.31, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.31, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.31, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.31, "10th_percentile": 7.31, "90th_percentile": 7.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.5, "10th_percentile": 8.5, "90th_percentile": 8.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 6.9% = $0.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 11.5% = $0.98 due to $0.00 Claim Price", "median_amount": 0.98, "10th_percentile": 0.98, "90th_percentile": 0.98, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 11.5% = $0.98 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 11.5% = $0.98 due to $0.00 Claim Price", "median_amount": 0.98, "10th_percentile": 0.98, "90th_percentile": 0.98, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8.50 @ 11.5% = $0.98 due to $0.00 Claim Price" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 4790.38, "maximum": 12619.13, "setting": "inpatient", "gross_charge": 26581.24, "discounted_cash": 18606.87, "payers_information": [ { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 22859.88, "10th_percentile": 22859.88, "90th_percentile": 22859.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 22859.88, "10th_percentile": 22859.88, "90th_percentile": 22859.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 22859.88, "10th_percentile": 22859.88, "90th_percentile": 22859.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 22859.88, "10th_percentile": 22859.88, "90th_percentile": 22859.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services; 100% Billed", "median_amount": 26581.25, "10th_percentile": 26581.25, "90th_percentile": 26581.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services; 100% Billed", "median_amount": 26581.25, "10th_percentile": 26581.25, "90th_percentile": 26581.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 26581.25, "10th_percentile": 26581.25, "90th_percentile": 26581.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services - OON; 100% Billed", "median_amount": 26581.25, "10th_percentile": 26581.25, "90th_percentile": 26581.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_percentage": 38.9, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; ALL INPATIENT; 38.9% Billed", "median_amount": 10340.11, "10th_percentile": 10340.11, "90th_percentile": 10340.11, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_percentage": 35.6, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All Inpatient Services; 35.6% Billed", "median_amount": 9462.93, "10th_percentile": 9462.93, "90th_percentile": 9462.93, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_percentage": 18.3, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 4864.37, "10th_percentile": 4864.37, "90th_percentile": 4864.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 11961.56, "10th_percentile": 11961.56, "90th_percentile": 11961.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_percentage": 92.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 24454.75, "10th_percentile": 24454.75, "90th_percentile": 24454.75, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_percentage": 76.1, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; Inpatient; 76.1% Billed", "median_amount": 20228.33, "10th_percentile": 20228.33, "90th_percentile": 20228.33, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; IP Services. ADP RATE (for patient estimates only); 49% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13024.81, "10th_percentile": 13024.81, "90th_percentile": 13024.81, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; Inpatient Services; 75% Billed", "median_amount": 19935.94, "10th_percentile": 19935.94, "90th_percentile": 19935.94, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_percentage": 78.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 20733.38, "10th_percentile": 20733.38, "90th_percentile": 20733.38, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_dollar": 4790.38, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $5,975.90; Total: $5,975.90 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5975.9, "10th_percentile": 5975.9, "90th_percentile": 5975.9, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $5,975.90; Total: $5,975.90 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 4790.38, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $5,975.90; Total: $5,975.90", "median_amount": 5975.9, "10th_percentile": 5975.9, "90th_percentile": 5975.9, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $5,975.90; Total: $5,975.90" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 4790.38, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $5,975.90; Total: $5,975.90", "median_amount": 5975.9, "10th_percentile": 5975.9, "90th_percentile": 5975.9, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $5,975.90; Total: $5,975.90" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 10069.73, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10069.73, "10th_percentile": 10069.73, "90th_percentile": 10069.73, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 12619.13, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12619.13, "10th_percentile": 12619.13, "90th_percentile": 12619.13, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8763.04, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 13,017.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE PREF STOP LOSS & LESSOR OF 9.*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8763.04, "10th_percentile": 8763.04, "90th_percentile": 8763.04, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 10069.73, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10069.73, "10th_percentile": 10069.73, "90th_percentile": 10069.73, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8345.66, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 12,397.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE SELECT STOP LOSS & LESSOR OF *; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8345.66, "10th_percentile": 8345.66, "90th_percentile": 8345.66, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 12619.13, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12619.13, "10th_percentile": 12619.13, "90th_percentile": 12619.13, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 9346.71, "standard_charge_algorithm": "Re-evaluated: HLB.824081444; Using historical claim(s); Scope: All Financial Classes; Cases: 6; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 13,884.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9346.71, "10th_percentile": 9346.71, "90th_percentile": 9346.71, "count": "1 through 10", "methodology": "case rate" } ] } ] }, { "description": "ATROPINE 1 % OPHT DROP", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-736", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60505-6226-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 119.27, "maximum": 651.75, "setting": "outpatient", "gross_charge": 651.75, "discounted_cash": 456.22, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 327.18, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 327.18, "10th_percentile": 327.18, "90th_percentile": 327.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 423.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 423.64, "10th_percentile": 423.64, "90th_percentile": 423.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 432.7, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 432.7, "10th_percentile": 432.7, "90th_percentile": 432.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 498.07, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 498.07, "10th_percentile": 498.07, "90th_percentile": 498.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 599.61, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 599.61, "10th_percentile": 599.61, "90th_percentile": 599.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 508.37, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 508.37, "10th_percentile": 508.37, "90th_percentile": 508.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 346.08, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 346.08, "10th_percentile": 346.08, "90th_percentile": 346.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 343.47, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 343.47, "10th_percentile": 343.47, "90th_percentile": 343.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 293.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 293.29, "10th_percentile": 293.29, "90th_percentile": 293.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 488.81, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 488.81, "10th_percentile": 488.81, "90th_percentile": 488.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 436.02, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 436.02, "10th_percentile": 436.02, "90th_percentile": 436.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 492.72, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 492.72, "10th_percentile": 492.72, "90th_percentile": 492.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 651.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 651.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 651.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 119.27, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 119.27, "10th_percentile": 119.27, "90th_percentile": 119.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 221.6, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 221.6, "10th_percentile": 221.6, "90th_percentile": 221.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 233.98, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 233.98, "10th_percentile": 233.98, "90th_percentile": 233.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 489.46, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 489.46, "10th_percentile": 489.46, "90th_percentile": 489.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 439.28, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 439.28, "10th_percentile": 439.28, "90th_percentile": 439.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 400.89, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 400.89, "10th_percentile": 400.89, "90th_percentile": 400.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 432.7, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 432.7, "10th_percentile": 432.7, "90th_percentile": 432.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 651.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 498.07, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 498.07, "10th_percentile": 498.07, "90th_percentile": 498.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 364.33, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 364.33, "10th_percentile": 364.33, "90th_percentile": 364.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 381.8, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 381.8, "10th_percentile": 381.8, "90th_percentile": 381.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 381.8, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 381.8, "10th_percentile": 381.8, "90th_percentile": 381.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 560.51, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 560.51, "10th_percentile": 560.51, "90th_percentile": 560.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 560.51, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 560.51, "10th_percentile": 560.51, "90th_percentile": 560.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 560.51, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 560.51, "10th_percentile": 560.51, "90th_percentile": 560.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 560.51, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 560.51, "10th_percentile": 560.51, "90th_percentile": 560.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 651.75, "10th_percentile": 651.75, "90th_percentile": 651.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AVANCE NERVE GRAFT 1-2MM X 30MM", "code_information": [ { "code": "SUP-163402", "type": "CDM" }, { "code": "C1762", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 3017.75, "maximum": 16490.41, "setting": "outpatient", "gross_charge": 16490.41, "discounted_cash": 11543.29, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 8690.45, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8690.45, "10th_percentile": 8690.45, "90th_percentile": 8690.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 8756.41, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8756.41, "10th_percentile": 8756.41, "90th_percentile": 8756.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 11032.08, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11032.08, "10th_percentile": 11032.08, "90th_percentile": 11032.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 10718.77, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 10718.77, "10th_percentile": 10718.77, "90th_percentile": 10718.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 8278.19, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8278.19, "10th_percentile": 8278.19, "90th_percentile": 8278.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 9218.14, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9218.14, "10th_percentile": 9218.14, "90th_percentile": 9218.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 12862.52, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 12862.52, "10th_percentile": 12862.52, "90th_percentile": 12862.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 12466.75, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 12466.75, "10th_percentile": 12466.75, "90th_percentile": 12466.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 12367.81, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 12367.81, "10th_percentile": 12367.81, "90th_percentile": 12367.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 16490.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 16490.41, "10th_percentile": 16490.41, "90th_percentile": 16490.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 16490.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 16490.41, "10th_percentile": 16490.41, "90th_percentile": 16490.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 7420.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 7420.68, "10th_percentile": 7420.68, "90th_percentile": 7420.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 15171.18, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 15171.18, "10th_percentile": 15171.18, "90th_percentile": 15171.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 11114.54, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11114.54, "10th_percentile": 11114.54, "90th_percentile": 11114.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 5920.06, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 5920.06, "10th_percentile": 5920.06, "90th_percentile": 5920.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 3017.75, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 3017.75, "10th_percentile": 3017.75, "90th_percentile": 3017.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 12384.3, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12384.3, "10th_percentile": 12384.3, "90th_percentile": 12384.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 5606.74, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 5606.74, "10th_percentile": 5606.74, "90th_percentile": 5606.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 11708.19, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11708.19, "10th_percentile": 11708.19, "90th_percentile": 11708.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 11708.19, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11708.19, "10th_percentile": 11708.19, "90th_percentile": 11708.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 16490.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16490.41, "10th_percentile": 16490.41, "90th_percentile": 16490.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 16490.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16490.41, "10th_percentile": 16490.41, "90th_percentile": 16490.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 10947.98, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 10947.98, "10th_percentile": 10947.98, "90th_percentile": 10947.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 10947.98, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 10947.98, "10th_percentile": 10947.98, "90th_percentile": 10947.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 9960.21, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9960.21, "10th_percentile": 9960.21, "90th_percentile": 9960.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 9960.21, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9960.21, "10th_percentile": 9960.21, "90th_percentile": 9960.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 9960.21, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9960.21, "10th_percentile": 9960.21, "90th_percentile": 9960.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 14181.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 14181.75, "10th_percentile": 14181.75, "90th_percentile": 14181.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 14181.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 14181.75, "10th_percentile": 14181.75, "90th_percentile": 14181.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 14181.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 14181.75, "10th_percentile": 14181.75, "90th_percentile": 14181.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 14181.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 14181.75, "10th_percentile": 14181.75, "90th_percentile": 14181.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1137.84, "10th_percentile": 1137.84, "90th_percentile": 1137.84, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1137.84, "10th_percentile": 1137.84, "90th_percentile": 1137.84, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1137.84, "10th_percentile": 1137.84, "90th_percentile": 1137.84, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1137.84, "10th_percentile": 1137.84, "90th_percentile": 1137.84, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1137.84, "10th_percentile": 1137.84, "90th_percentile": 1137.84, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1137.84, "10th_percentile": 1137.84, "90th_percentile": 1137.84, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1137.84, "10th_percentile": 1137.84, "90th_percentile": 1137.84, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 6.9% = $1,137.84 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 11.5% = $1,896.40 due to $0.00 Claim Price", "median_amount": 1896.4, "10th_percentile": 1896.4, "90th_percentile": 1896.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 11.5% = $1,896.40 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 11.5% = $1,896.40 due to $0.00 Claim Price", "median_amount": 1896.4, "10th_percentile": 1896.4, "90th_percentile": 1896.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,490.41 @ 11.5% = $1,896.40 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16490.41, "10th_percentile": 16490.41, "90th_percentile": 16490.41, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AZITHROMYCIN 250 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-20943", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "59762-3060-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 28.73, "maximum": 157.0, "setting": "outpatient", "gross_charge": 157.0, "discounted_cash": 109.9, "payers_information": [ { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 102.05, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 102.05, "10th_percentile": 102.05, "90th_percentile": 102.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 117.75, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 117.75, "10th_percentile": 117.75, "90th_percentile": 117.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 70.65, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 70.65, "10th_percentile": 70.65, "90th_percentile": 70.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 157.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 78.81, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.81, "10th_percentile": 78.81, "90th_percentile": 78.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 144.44, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 144.44, "10th_percentile": 144.44, "90th_percentile": 144.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 122.46, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 122.46, "10th_percentile": 122.46, "90th_percentile": 122.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 105.03, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 105.03, "10th_percentile": 105.03, "90th_percentile": 105.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 87.76, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 87.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 118.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 118.69, "10th_percentile": 118.69, "90th_percentile": 118.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 157.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 28.73, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 28.73, "10th_percentile": 28.73, "90th_percentile": 28.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 53.38, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 53.38, "10th_percentile": 53.38, "90th_percentile": 53.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 56.36, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 56.36, "10th_percentile": 56.36, "90th_percentile": 56.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 117.91, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 117.91, "10th_percentile": 117.91, "90th_percentile": 117.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 105.82, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 105.82, "10th_percentile": 105.82, "90th_percentile": 105.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 104.23, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 104.23, "10th_percentile": 104.23, "90th_percentile": 104.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 104.23, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 104.23, "10th_percentile": 104.23, "90th_percentile": 104.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 111.47, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 111.47, "10th_percentile": 111.47, "90th_percentile": 111.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 111.47, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 111.47, "10th_percentile": 111.47, "90th_percentile": 111.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 157.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 157.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 94.83, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.83, "10th_percentile": 94.83, "90th_percentile": 94.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 94.83, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.83, "10th_percentile": 94.83, "90th_percentile": 94.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 94.83, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.83, "10th_percentile": 94.83, "90th_percentile": 94.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 135.02, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 135.02, "10th_percentile": 135.02, "90th_percentile": 135.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 135.02, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 135.02, "10th_percentile": 135.02, "90th_percentile": 135.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 135.02, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 135.02, "10th_percentile": 135.02, "90th_percentile": 135.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 135.02, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 135.02, "10th_percentile": 135.02, "90th_percentile": 135.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 157.0, "10th_percentile": 157.0, "90th_percentile": 157.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.83, "10th_percentile": 10.83, "90th_percentile": 10.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.83, "10th_percentile": 10.83, "90th_percentile": 10.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.83, "10th_percentile": 10.83, "90th_percentile": 10.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.83, "10th_percentile": 10.83, "90th_percentile": 10.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.83, "10th_percentile": 10.83, "90th_percentile": 10.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.83, "10th_percentile": 10.83, "90th_percentile": 10.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.83, "10th_percentile": 10.83, "90th_percentile": 10.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 6.9% = $10.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 11.5% = $18.06 due to $0.00 Claim Price", "median_amount": 18.06, "10th_percentile": 18.06, "90th_percentile": 18.06, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 11.5% = $18.06 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 11.5% = $18.06 due to $0.00 Claim Price", "median_amount": 18.06, "10th_percentile": 18.06, "90th_percentile": 18.06, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $157.00 @ 11.5% = $18.06 due to $0.00 Claim Price" } ] } ] }, { "description": "Adult Oxygen Mask Non-Rebreather 7Ft", "code_information": [ { "code": "SUP-161453", "type": "CDM" }, { "code": "27103350", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 5.67, "maximum": 30.98, "setting": "outpatient", "gross_charge": 30.98, "discounted_cash": 21.69, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 26.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 26.64, "10th_percentile": 26.64, "90th_percentile": 26.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 26.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 26.64, "10th_percentile": 26.64, "90th_percentile": 26.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 26.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 26.64, "10th_percentile": 26.64, "90th_percentile": 26.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 26.64, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 26.64, "10th_percentile": 26.64, "90th_percentile": 26.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 17.32, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.32, "10th_percentile": 17.32, "90th_percentile": 17.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 20.57, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 20.57, "10th_percentile": 20.57, "90th_percentile": 20.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 23.67, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.67, "10th_percentile": 23.67, "90th_percentile": 23.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 19.06, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.06, "10th_percentile": 19.06, "90th_percentile": 19.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 18.15, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.15, "10th_percentile": 18.15, "90th_percentile": 18.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 18.15, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.15, "10th_percentile": 18.15, "90th_percentile": 18.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 20.88, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.88, "10th_percentile": 20.88, "90th_percentile": 20.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 23.27, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.27, "10th_percentile": 23.27, "90th_percentile": 23.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 11.12, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 11.12, "10th_percentile": 11.12, "90th_percentile": 11.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 10.53, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 10.53, "10th_percentile": 10.53, "90th_percentile": 10.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.67, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 5.67, "10th_percentile": 5.67, "90th_percentile": 5.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 30.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 30.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 30.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 23.42, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 23.42, "10th_percentile": 23.42, "90th_percentile": 23.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 20.73, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.73, "10th_percentile": 20.73, "90th_percentile": 20.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 20.14, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 20.14, "10th_percentile": 20.14, "90th_percentile": 20.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 28.5, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 28.5, "10th_percentile": 28.5, "90th_percentile": 28.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 16.45, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.45, "10th_percentile": 16.45, "90th_percentile": 16.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 20.57, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 20.57, "10th_percentile": 20.57, "90th_percentile": 20.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 15.55, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15.55, "10th_percentile": 15.55, "90th_percentile": 15.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 13.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 13.94, "10th_percentile": 13.94, "90th_percentile": 13.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 16.33, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16.33, "10th_percentile": 16.33, "90th_percentile": 16.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 23.67, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.67, "10th_percentile": 23.67, "90th_percentile": 23.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 23.24, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 23.24, "10th_percentile": 23.24, "90th_percentile": 23.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 24.16, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 24.16, "10th_percentile": 24.16, "90th_percentile": 24.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 30.98, "10th_percentile": 30.98, "90th_percentile": 30.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "Apex RX Balloon 2.5 x 15mm", "code_information": [ { "code": "SUP-301832", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 108.48, "maximum": 592.76, "setting": "outpatient", "gross_charge": 592.76, "discounted_cash": 414.93, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 444.57, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 444.57, "10th_percentile": 444.57, "90th_percentile": 444.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 331.35, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 331.35, "10th_percentile": 331.35, "90th_percentile": 331.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 396.56, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 396.56, "10th_percentile": 396.56, "90th_percentile": 396.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 545.34, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 545.34, "10th_percentile": 545.34, "90th_percentile": 545.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 266.74, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 266.74, "10th_percentile": 266.74, "90th_percentile": 266.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 448.13, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 448.13, "10th_percentile": 448.13, "90th_percentile": 448.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 314.76, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 314.76, "10th_percentile": 314.76, "90th_percentile": 314.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 462.35, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 462.35, "10th_percentile": 462.35, "90th_percentile": 462.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 385.29, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 385.29, "10th_percentile": 385.29, "90th_percentile": 385.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 297.57, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 297.57, "10th_percentile": 297.57, "90th_percentile": 297.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 312.38, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 312.38, "10th_percentile": 312.38, "90th_percentile": 312.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 201.54, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 201.54, "10th_percentile": 201.54, "90th_percentile": 201.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 399.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 399.52, "10th_percentile": 399.52, "90th_percentile": 399.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 445.16, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 445.16, "10th_percentile": 445.16, "90th_percentile": 445.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 212.8, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 212.8, "10th_percentile": 212.8, "90th_percentile": 212.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 108.48, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 108.48, "10th_percentile": 108.48, "90th_percentile": 108.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 393.53, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 393.53, "10th_percentile": 393.53, "90th_percentile": 393.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 393.53, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 393.53, "10th_percentile": 393.53, "90th_percentile": 393.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 420.86, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 420.86, "10th_percentile": 420.86, "90th_percentile": 420.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 420.86, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 420.86, "10th_percentile": 420.86, "90th_percentile": 420.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 358.03, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 358.03, "10th_percentile": 358.03, "90th_percentile": 358.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 358.03, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 358.03, "10th_percentile": 358.03, "90th_percentile": 358.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 358.03, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 358.03, "10th_percentile": 358.03, "90th_percentile": 358.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price", "median_amount": 68.17, "10th_percentile": 68.17, "90th_percentile": 68.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price", "median_amount": 68.17, "10th_percentile": 68.17, "90th_percentile": 68.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "Apex RX Balloon 3.0 x 15mm", "code_information": [ { "code": "SUP-125194", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 108.48, "maximum": 592.76, "setting": "outpatient", "gross_charge": 592.76, "discounted_cash": 414.93, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 444.57, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 444.57, "10th_percentile": 444.57, "90th_percentile": 444.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 331.35, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 331.35, "10th_percentile": 331.35, "90th_percentile": 331.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 396.56, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 396.56, "10th_percentile": 396.56, "90th_percentile": 396.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 545.34, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 545.34, "10th_percentile": 545.34, "90th_percentile": 545.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 266.74, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 266.74, "10th_percentile": 266.74, "90th_percentile": 266.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 448.13, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 448.13, "10th_percentile": 448.13, "90th_percentile": 448.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 314.76, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 314.76, "10th_percentile": 314.76, "90th_percentile": 314.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 462.35, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 462.35, "10th_percentile": 462.35, "90th_percentile": 462.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 385.29, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 385.29, "10th_percentile": 385.29, "90th_percentile": 385.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 297.57, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 297.57, "10th_percentile": 297.57, "90th_percentile": 297.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 312.38, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 312.38, "10th_percentile": 312.38, "90th_percentile": 312.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 201.54, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 201.54, "10th_percentile": 201.54, "90th_percentile": 201.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 399.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 399.52, "10th_percentile": 399.52, "90th_percentile": 399.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 445.16, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 445.16, "10th_percentile": 445.16, "90th_percentile": 445.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 212.8, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 212.8, "10th_percentile": 212.8, "90th_percentile": 212.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 108.48, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 108.48, "10th_percentile": 108.48, "90th_percentile": 108.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 393.53, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 393.53, "10th_percentile": 393.53, "90th_percentile": 393.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 393.53, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 393.53, "10th_percentile": 393.53, "90th_percentile": 393.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 420.86, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 420.86, "10th_percentile": 420.86, "90th_percentile": 420.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 420.86, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 420.86, "10th_percentile": 420.86, "90th_percentile": 420.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 358.03, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 358.03, "10th_percentile": 358.03, "90th_percentile": 358.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 358.03, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 358.03, "10th_percentile": 358.03, "90th_percentile": 358.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 358.03, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 358.03, "10th_percentile": 358.03, "90th_percentile": 358.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price", "median_amount": 68.17, "10th_percentile": 68.17, "90th_percentile": 68.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price", "median_amount": 68.17, "10th_percentile": 68.17, "90th_percentile": 68.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "Apex RX Balloon 4.0 x 40mm", "code_information": [ { "code": "SUP-313885", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 108.48, "maximum": 592.76, "setting": "outpatient", "gross_charge": 592.76, "discounted_cash": 414.93, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 444.57, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 444.57, "10th_percentile": 444.57, "90th_percentile": 444.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 331.35, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 331.35, "10th_percentile": 331.35, "90th_percentile": 331.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 396.56, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 396.56, "10th_percentile": 396.56, "90th_percentile": 396.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 545.34, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 545.34, "10th_percentile": 545.34, "90th_percentile": 545.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 266.74, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 266.74, "10th_percentile": 266.74, "90th_percentile": 266.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 448.13, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 448.13, "10th_percentile": 448.13, "90th_percentile": 448.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 314.76, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 314.76, "10th_percentile": 314.76, "90th_percentile": 314.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 462.35, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 462.35, "10th_percentile": 462.35, "90th_percentile": 462.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 385.29, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 385.29, "10th_percentile": 385.29, "90th_percentile": 385.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 297.57, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 297.57, "10th_percentile": 297.57, "90th_percentile": 297.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 312.38, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 312.38, "10th_percentile": 312.38, "90th_percentile": 312.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 201.54, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 201.54, "10th_percentile": 201.54, "90th_percentile": 201.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 399.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 399.52, "10th_percentile": 399.52, "90th_percentile": 399.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 445.16, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 445.16, "10th_percentile": 445.16, "90th_percentile": 445.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 212.8, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 212.8, "10th_percentile": 212.8, "90th_percentile": 212.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 108.48, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 108.48, "10th_percentile": 108.48, "90th_percentile": 108.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 393.53, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 393.53, "10th_percentile": 393.53, "90th_percentile": 393.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 393.53, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 393.53, "10th_percentile": 393.53, "90th_percentile": 393.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 420.86, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 420.86, "10th_percentile": 420.86, "90th_percentile": 420.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 420.86, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 420.86, "10th_percentile": 420.86, "90th_percentile": 420.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 358.03, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 358.03, "10th_percentile": 358.03, "90th_percentile": 358.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 358.03, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 358.03, "10th_percentile": 358.03, "90th_percentile": 358.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 358.03, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 358.03, "10th_percentile": 358.03, "90th_percentile": 358.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 592.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 509.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 509.77, "10th_percentile": 509.77, "90th_percentile": 509.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 40.9, "10th_percentile": 40.9, "90th_percentile": 40.9, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 6.9% = $40.90 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price", "median_amount": 68.17, "10th_percentile": 68.17, "90th_percentile": 68.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price", "median_amount": 68.17, "10th_percentile": 68.17, "90th_percentile": 68.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $592.76 @ 11.5% = $68.17 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 592.76, "10th_percentile": 592.76, "90th_percentile": 592.76, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BALLOON CATHETER EVERCROSS 6 X 40 MM .035 X 80 CM OTW", "code_information": [ { "code": "SUP-306729", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 81.67, "maximum": 446.31, "setting": "outpatient", "gross_charge": 446.31, "discounted_cash": 312.42, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 249.49, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 249.49, "10th_percentile": 249.49, "90th_percentile": 249.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 298.58, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 235.21, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 235.21, "10th_percentile": 235.21, "90th_percentile": 235.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 236.99, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 236.99, "10th_percentile": 236.99, "90th_percentile": 236.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 224.05, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.05, "10th_percentile": 224.05, "90th_percentile": 224.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 410.61, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 410.61, "10th_percentile": 410.61, "90th_percentile": 410.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 348.12, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 348.12, "10th_percentile": 348.12, "90th_percentile": 348.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 334.73, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 334.73, "10th_percentile": 334.73, "90th_percentile": 334.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 200.84, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 200.84, "10th_percentile": 200.84, "90th_percentile": 200.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 337.41, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 337.41, "10th_percentile": 337.41, "90th_percentile": 337.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 290.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 290.1, "10th_percentile": 290.1, "90th_percentile": 290.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 81.67, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 81.67, "10th_percentile": 81.67, "90th_percentile": 81.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 151.75, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 151.75, "10th_percentile": 151.75, "90th_percentile": 151.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 300.81, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 300.81, "10th_percentile": 300.81, "90th_percentile": 300.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 335.18, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 335.18, "10th_percentile": 335.18, "90th_percentile": 335.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 160.23, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 160.23, "10th_percentile": 160.23, "90th_percentile": 160.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 296.31, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 296.31, "10th_percentile": 296.31, "90th_percentile": 296.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 296.31, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 296.31, "10th_percentile": 296.31, "90th_percentile": 296.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 316.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.88, "10th_percentile": 316.88, "90th_percentile": 316.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 316.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.88, "10th_percentile": 316.88, "90th_percentile": 316.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price", "median_amount": 51.33, "10th_percentile": 51.33, "90th_percentile": 51.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price", "median_amount": 51.33, "10th_percentile": 51.33, "90th_percentile": 51.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BALLOON ENDOCAVITY 2X14CM NONSTRL", "code_information": [ { "code": "SUP-319743", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 70.76, "maximum": 386.68, "setting": "outpatient", "gross_charge": 386.68, "discounted_cash": 270.68, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 332.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 332.54, "10th_percentile": 332.54, "90th_percentile": 332.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 332.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 332.54, "10th_percentile": 332.54, "90th_percentile": 332.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 332.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 332.54, "10th_percentile": 332.54, "90th_percentile": 332.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 332.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 332.54, "10th_percentile": 332.54, "90th_percentile": 332.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 237.85, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 237.85, "10th_percentile": 237.85, "90th_percentile": 237.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 295.5, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 295.5, "10th_percentile": 295.5, "90th_percentile": 295.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 216.15, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 216.15, "10th_percentile": 216.15, "90th_percentile": 216.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 386.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 256.72, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 256.72, "10th_percentile": 256.72, "90th_percentile": 256.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 226.52, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.52, "10th_percentile": 226.52, "90th_percentile": 226.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 226.52, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.52, "10th_percentile": 226.52, "90th_percentile": 226.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 70.76, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 70.76, "10th_percentile": 70.76, "90th_percentile": 70.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 138.82, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 138.82, "10th_percentile": 138.82, "90th_percentile": 138.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 260.62, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.62, "10th_percentile": 260.62, "90th_percentile": 260.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 131.47, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 131.47, "10th_percentile": 131.47, "90th_percentile": 131.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 290.4, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 290.4, "10th_percentile": 290.4, "90th_percentile": 290.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 386.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 386.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 386.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 258.69, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 258.69, "10th_percentile": 258.69, "90th_percentile": 258.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 355.75, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 355.75, "10th_percentile": 355.75, "90th_percentile": 355.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 203.78, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 203.78, "10th_percentile": 203.78, "90th_percentile": 203.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 205.33, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 205.33, "10th_percentile": 205.33, "90th_percentile": 205.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 301.61, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 301.61, "10th_percentile": 301.61, "90th_percentile": 301.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 174.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 174.01, "10th_percentile": 174.01, "90th_percentile": 174.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 256.72, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 256.72, "10th_percentile": 256.72, "90th_percentile": 256.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 290.01, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 290.01, "10th_percentile": 290.01, "90th_percentile": 290.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 295.5, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 295.5, "10th_percentile": 295.5, "90th_percentile": 295.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 251.34, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 251.34, "10th_percentile": 251.34, "90th_percentile": 251.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 194.11, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 194.11, "10th_percentile": 194.11, "90th_percentile": 194.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 292.33, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 292.33, "10th_percentile": 292.33, "90th_percentile": 292.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 386.68, "10th_percentile": 386.68, "90th_percentile": 386.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BANDAGE D STAT HEMOSTATIC", "code_information": [ { "code": "SUP-321553", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 51.3, "maximum": 280.34, "setting": "outpatient", "gross_charge": 280.34, "discounted_cash": 196.24, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 241.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 241.09, "10th_percentile": 241.09, "90th_percentile": 241.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 241.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 241.09, "10th_percentile": 241.09, "90th_percentile": 241.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 241.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 241.09, "10th_percentile": 241.09, "90th_percentile": 241.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 241.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 241.09, "10th_percentile": 241.09, "90th_percentile": 241.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 172.44, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 172.44, "10th_percentile": 172.44, "90th_percentile": 172.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 214.24, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 214.24, "10th_percentile": 214.24, "90th_percentile": 214.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 156.71, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 156.71, "10th_percentile": 156.71, "90th_percentile": 156.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 280.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 186.12, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 186.12, "10th_percentile": 186.12, "90th_percentile": 186.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 164.22, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 164.22, "10th_percentile": 164.22, "90th_percentile": 164.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 164.22, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 164.22, "10th_percentile": 164.22, "90th_percentile": 164.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 51.3, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 51.3, "10th_percentile": 51.3, "90th_percentile": 51.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 100.64, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 100.64, "10th_percentile": 100.64, "90th_percentile": 100.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 188.95, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 188.95, "10th_percentile": 188.95, "90th_percentile": 188.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 95.32, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 95.32, "10th_percentile": 95.32, "90th_percentile": 95.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 210.54, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 210.54, "10th_percentile": 210.54, "90th_percentile": 210.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 280.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 280.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 280.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 187.55, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.55, "10th_percentile": 187.55, "90th_percentile": 187.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 257.91, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 257.91, "10th_percentile": 257.91, "90th_percentile": 257.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 147.74, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 147.74, "10th_percentile": 147.74, "90th_percentile": 147.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 148.86, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 148.86, "10th_percentile": 148.86, "90th_percentile": 148.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 218.67, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 218.67, "10th_percentile": 218.67, "90th_percentile": 218.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 126.15, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 126.15, "10th_percentile": 126.15, "90th_percentile": 126.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 186.12, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 186.12, "10th_percentile": 186.12, "90th_percentile": 186.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 210.26, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 210.26, "10th_percentile": 210.26, "90th_percentile": 210.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 214.24, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 214.24, "10th_percentile": 214.24, "90th_percentile": 214.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 182.22, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 182.22, "10th_percentile": 182.22, "90th_percentile": 182.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 140.73, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.73, "10th_percentile": 140.73, "90th_percentile": 140.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 211.94, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 211.94, "10th_percentile": 211.94, "90th_percentile": 211.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.34, "10th_percentile": 280.34, "90th_percentile": 280.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BANDAGE FOAM COFLEX LF2 4IN 5YD TAN STERILE", "code_information": [ { "code": "SUP-416682", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 6.55, "maximum": 35.78, "setting": "outpatient", "gross_charge": 35.78, "discounted_cash": 25.05, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 30.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 30.77, "10th_percentile": 30.77, "90th_percentile": 30.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 30.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 30.77, "10th_percentile": 30.77, "90th_percentile": 30.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 30.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 30.77, "10th_percentile": 30.77, "90th_percentile": 30.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 30.77, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 30.77, "10th_percentile": 30.77, "90th_percentile": 30.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 22.01, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.01, "10th_percentile": 22.01, "90th_percentile": 22.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 27.34, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.34, "10th_percentile": 27.34, "90th_percentile": 27.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 20.0, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.0, "10th_percentile": 20.0, "90th_percentile": 20.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 35.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 23.75, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 23.75, "10th_percentile": 23.75, "90th_percentile": 23.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 20.96, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.96, "10th_percentile": 20.96, "90th_percentile": 20.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 20.96, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.96, "10th_percentile": 20.96, "90th_percentile": 20.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 6.55, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 6.55, "10th_percentile": 6.55, "90th_percentile": 6.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 12.85, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 12.85, "10th_percentile": 12.85, "90th_percentile": 12.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 24.12, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.12, "10th_percentile": 24.12, "90th_percentile": 24.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 12.17, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 12.17, "10th_percentile": 12.17, "90th_percentile": 12.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 26.87, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.87, "10th_percentile": 26.87, "90th_percentile": 26.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 35.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 35.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 35.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 23.94, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.94, "10th_percentile": 23.94, "90th_percentile": 23.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 32.92, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 32.92, "10th_percentile": 32.92, "90th_percentile": 32.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 18.86, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18.86, "10th_percentile": 18.86, "90th_percentile": 18.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 19.0, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19.0, "10th_percentile": 19.0, "90th_percentile": 19.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 27.91, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 27.91, "10th_percentile": 27.91, "90th_percentile": 27.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 16.1, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 16.1, "10th_percentile": 16.1, "90th_percentile": 16.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 23.75, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 23.75, "10th_percentile": 23.75, "90th_percentile": 23.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 26.84, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 26.84, "10th_percentile": 26.84, "90th_percentile": 26.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 27.34, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.34, "10th_percentile": 27.34, "90th_percentile": 27.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 23.26, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 23.26, "10th_percentile": 23.26, "90th_percentile": 23.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 17.96, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 17.96, "10th_percentile": 17.96, "90th_percentile": 17.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 27.05, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 27.05, "10th_percentile": 27.05, "90th_percentile": 27.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35.78, "10th_percentile": 35.78, "90th_percentile": 35.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BARD VIKING DIAG CS DECAPOLAR CATH FIXED CURVE 6FR", "code_information": [ { "code": "SUP-120964", "type": "CDM" }, { "code": "C1730", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 216.95, "maximum": 1185.51, "setting": "outpatient", "gross_charge": 1185.51, "discounted_cash": 829.86, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1185.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1185.51, "10th_percentile": 1185.51, "90th_percentile": 1185.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1185.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1185.51, "10th_percentile": 1185.51, "90th_percentile": 1185.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 841.71, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 841.71, "10th_percentile": 841.71, "90th_percentile": 841.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 841.71, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 841.71, "10th_percentile": 841.71, "90th_percentile": 841.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 216.95, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 216.95, "10th_percentile": 216.95, "90th_percentile": 216.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 403.07, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 403.07, "10th_percentile": 403.07, "90th_percentile": 403.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 425.6, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 425.6, "10th_percentile": 425.6, "90th_percentile": 425.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 890.32, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 890.32, "10th_percentile": 890.32, "90th_percentile": 890.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 799.03, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 799.03, "10th_percentile": 799.03, "90th_percentile": 799.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 896.25, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 896.25, "10th_percentile": 896.25, "90th_percentile": 896.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 629.51, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 629.51, "10th_percentile": 629.51, "90th_percentile": 629.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 624.76, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 624.76, "10th_percentile": 624.76, "90th_percentile": 624.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1090.67, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1090.67, "10th_percentile": 1090.67, "90th_percentile": 1090.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 533.48, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 533.48, "10th_percentile": 533.48, "90th_percentile": 533.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 889.13, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 889.13, "10th_percentile": 889.13, "90th_percentile": 889.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 924.7, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 924.7, "10th_percentile": 924.7, "90th_percentile": 924.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1185.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1185.51, "10th_percentile": 1185.51, "90th_percentile": 1185.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 770.58, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 770.58, "10th_percentile": 770.58, "90th_percentile": 770.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 595.13, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 595.13, "10th_percentile": 595.13, "90th_percentile": 595.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 793.11, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.11, "10th_percentile": 793.11, "90th_percentile": 793.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1185.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1185.51, "10th_percentile": 1185.51, "90th_percentile": 1185.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 662.7, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 662.7, "10th_percentile": 662.7, "90th_percentile": 662.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 787.06, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 787.06, "10th_percentile": 787.06, "90th_percentile": 787.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 787.06, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 787.06, "10th_percentile": 787.06, "90th_percentile": 787.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 716.05, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 716.05, "10th_percentile": 716.05, "90th_percentile": 716.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 716.05, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 716.05, "10th_percentile": 716.05, "90th_percentile": 716.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 716.05, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 716.05, "10th_percentile": 716.05, "90th_percentile": 716.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1019.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1019.54, "10th_percentile": 1019.54, "90th_percentile": 1019.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1019.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1019.54, "10th_percentile": 1019.54, "90th_percentile": 1019.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1019.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1019.54, "10th_percentile": 1019.54, "90th_percentile": 1019.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1019.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1019.54, "10th_percentile": 1019.54, "90th_percentile": 1019.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 81.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 81.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 81.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 81.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 81.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 81.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 81.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 6.9% = $81.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 11.5% = $136.33 due to $0.00 Claim Price", "median_amount": 136.33, "10th_percentile": 136.33, "90th_percentile": 136.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 11.5% = $136.33 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 11.5% = $136.33 due to $0.00 Claim Price", "median_amount": 136.33, "10th_percentile": 136.33, "90th_percentile": 136.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,185.51 @ 11.5% = $136.33 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1185.51, "10th_percentile": 1185.51, "90th_percentile": 1185.51, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BASEPLATE COMPONENT AUGMENT REV 110032420", "code_information": [ { "code": "SUP-344619", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2611.41, "maximum": 14270.0, "setting": "outpatient", "gross_charge": 14270.0, "discounted_cash": 9989.0, "payers_information": [ { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 6.9% = $984.63 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12272.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12272.2, "10th_percentile": 12272.2, "90th_percentile": 12272.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12272.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12272.2, "10th_percentile": 12272.2, "90th_percentile": 12272.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12272.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12272.2, "10th_percentile": 12272.2, "90th_percentile": 12272.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12272.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12272.2, "10th_percentile": 12272.2, "90th_percentile": 12272.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 8619.08, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8619.08, "10th_percentile": 8619.08, "90th_percentile": 8619.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8619.08, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8619.08, "10th_percentile": 8619.08, "90th_percentile": 8619.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8619.08, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8619.08, "10th_percentile": 8619.08, "90th_percentile": 8619.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9473.85, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9473.85, "10th_percentile": 9473.85, "90th_percentile": 9473.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9473.85, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9473.85, "10th_percentile": 9473.85, "90th_percentile": 9473.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14270.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14270.0, "10th_percentile": 14270.0, "90th_percentile": 14270.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14270.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14270.0, "10th_percentile": 14270.0, "90th_percentile": 14270.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10131.7, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10131.7, "10th_percentile": 10131.7, "90th_percentile": 10131.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10131.7, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10131.7, "10th_percentile": 10131.7, "90th_percentile": 10131.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 10716.77, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10716.77, "10th_percentile": 10716.77, "90th_percentile": 10716.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 2611.41, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 2611.41, "10th_percentile": 2611.41, "90th_percentile": 2611.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 5122.93, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 5122.93, "10th_percentile": 5122.93, "90th_percentile": 5122.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 9617.98, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9617.98, "10th_percentile": 9617.98, "90th_percentile": 9617.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 4851.8, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 4851.8, "10th_percentile": 4851.8, "90th_percentile": 4851.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 7520.29, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3408.23, "10th_percentile": 3408.23, "90th_percentile": 3408.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 9275.5, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 9275.5, "10th_percentile": 9275.5, "90th_percentile": 9275.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 7577.37, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7577.37, "10th_percentile": 7577.37, "90th_percentile": 7577.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 9546.63, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9546.63, "10th_percentile": 9546.63, "90th_percentile": 9546.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14270.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14270.0, "10th_percentile": 14270.0, "90th_percentile": 14270.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 7163.54, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7163.54, "10th_percentile": 7163.54, "90th_percentile": 7163.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 13128.4, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 13128.4, "10th_percentile": 13128.4, "90th_percentile": 13128.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 10788.12, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 10788.12, "10th_percentile": 10788.12, "90th_percentile": 10788.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7976.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7976.93, "10th_percentile": 7976.93, "90th_percentile": 7976.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 14270.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 14270.0, "10th_percentile": 14270.0, "90th_percentile": 14270.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 10702.5, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 10702.5, "10th_percentile": 10702.5, "90th_percentile": 10702.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 6421.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 6421.5, "10th_percentile": 6421.5, "90th_percentile": 6421.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 11130.6, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 11130.6, "10th_percentile": 11130.6, "90th_percentile": 11130.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 11.5% = $1,641.05 due to $0.00 Claim Price", "median_amount": 1641.05, "10th_percentile": 1641.05, "90th_percentile": 1641.05, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 11.5% = $1,641.05 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 11.5% = $1,641.05 due to $0.00 Claim Price", "median_amount": 1641.05, "10th_percentile": 1641.05, "90th_percentile": 1641.05, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,270.00 @ 11.5% = $1,641.05 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14270.0, "10th_percentile": 14270.0, "90th_percentile": 14270.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BASEPLATE TIB STEM CEM PERSONA SZ H 5DEG L", "code_information": [ { "code": "SUP-147637", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 715.29, "maximum": 3908.7, "setting": "outpatient", "gross_charge": 3908.7, "discounted_cash": 2736.09, "payers_information": [ { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3361.48, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3361.48, "10th_percentile": 3361.48, "90th_percentile": 3361.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3361.48, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3361.48, "10th_percentile": 3361.48, "90th_percentile": 3361.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3361.48, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3361.48, "10th_percentile": 3361.48, "90th_percentile": 3361.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3361.48, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3361.48, "10th_percentile": 3361.48, "90th_percentile": 3361.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2360.85, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2360.85, "10th_percentile": 2360.85, "90th_percentile": 2360.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2360.85, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2360.85, "10th_percentile": 2360.85, "90th_percentile": 2360.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2360.85, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2360.85, "10th_percentile": 2360.85, "90th_percentile": 2360.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2594.99, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2594.99, "10th_percentile": 2594.99, "90th_percentile": 2594.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2594.99, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2594.99, "10th_percentile": 2594.99, "90th_percentile": 2594.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3908.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3908.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2775.18, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2775.18, "10th_percentile": 2775.18, "90th_percentile": 2775.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2775.18, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2775.18, "10th_percentile": 2775.18, "90th_percentile": 2775.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 2935.43, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2935.43, "10th_percentile": 2935.43, "90th_percentile": 2935.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 715.29, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 715.29, "10th_percentile": 715.29, "90th_percentile": 715.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1403.22, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1403.22, "10th_percentile": 1403.22, "90th_percentile": 1403.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 2634.46, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2634.46, "10th_percentile": 2634.46, "90th_percentile": 2634.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1328.96, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1328.96, "10th_percentile": 1328.96, "90th_percentile": 1328.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 2059.88, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3408.23, "10th_percentile": 3408.23, "90th_percentile": 3408.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 2540.66, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 2540.66, "10th_percentile": 2540.66, "90th_percentile": 2540.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 2075.52, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2075.52, "10th_percentile": 2075.52, "90th_percentile": 2075.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 2614.92, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2614.92, "10th_percentile": 2614.92, "90th_percentile": 2614.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3908.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1962.17, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1962.17, "10th_percentile": 1962.17, "90th_percentile": 1962.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 3596.0, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 3596.0, "10th_percentile": 3596.0, "90th_percentile": 3596.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2954.98, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2954.98, "10th_percentile": 2954.98, "90th_percentile": 2954.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2184.96, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2184.96, "10th_percentile": 2184.96, "90th_percentile": 2184.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 3908.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2931.53, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2931.53, "10th_percentile": 2931.53, "90th_percentile": 2931.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1758.92, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1758.92, "10th_percentile": 1758.92, "90th_percentile": 1758.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 3048.79, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 3048.79, "10th_percentile": 3048.79, "90th_percentile": 3048.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 11.5% = $449.50 due to $0.00 Claim Price", "median_amount": 449.5, "10th_percentile": 449.5, "90th_percentile": 449.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 11.5% = $449.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 11.5% = $449.50 due to $0.00 Claim Price", "median_amount": 449.5, "10th_percentile": 449.5, "90th_percentile": 449.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 11.5% = $449.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BASEPLATE TIB STEM CEM PERSONA SZ H 5DEG R", "code_information": [ { "code": "SUP-147638", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 715.29, "maximum": 3908.7, "setting": "outpatient", "gross_charge": 3908.7, "discounted_cash": 2736.09, "payers_information": [ { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1165.93, "10th_percentile": 1165.93, "90th_percentile": 1165.93, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 6.9% = $269.70 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3361.48, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3361.48, "10th_percentile": 3361.48, "90th_percentile": 3361.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3361.48, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3361.48, "10th_percentile": 3361.48, "90th_percentile": 3361.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3361.48, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3361.48, "10th_percentile": 3361.48, "90th_percentile": 3361.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3361.48, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3361.48, "10th_percentile": 3361.48, "90th_percentile": 3361.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2360.85, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2360.85, "10th_percentile": 2360.85, "90th_percentile": 2360.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2360.85, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2360.85, "10th_percentile": 2360.85, "90th_percentile": 2360.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2360.85, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2360.85, "10th_percentile": 2360.85, "90th_percentile": 2360.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2594.99, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2594.99, "10th_percentile": 2594.99, "90th_percentile": 2594.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2594.99, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2594.99, "10th_percentile": 2594.99, "90th_percentile": 2594.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3908.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3908.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2775.18, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2775.18, "10th_percentile": 2775.18, "90th_percentile": 2775.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2775.18, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2775.18, "10th_percentile": 2775.18, "90th_percentile": 2775.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 2935.43, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2935.43, "10th_percentile": 2935.43, "90th_percentile": 2935.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 715.29, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 715.29, "10th_percentile": 715.29, "90th_percentile": 715.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1403.22, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1403.22, "10th_percentile": 1403.22, "90th_percentile": 1403.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 2634.46, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2634.46, "10th_percentile": 2634.46, "90th_percentile": 2634.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1328.96, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1328.96, "10th_percentile": 1328.96, "90th_percentile": 1328.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 2059.88, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3408.23, "10th_percentile": 3408.23, "90th_percentile": 3408.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 2540.66, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 2540.66, "10th_percentile": 2540.66, "90th_percentile": 2540.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 2075.52, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2075.52, "10th_percentile": 2075.52, "90th_percentile": 2075.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 2614.92, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2614.92, "10th_percentile": 2614.92, "90th_percentile": 2614.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3908.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1962.17, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1962.17, "10th_percentile": 1962.17, "90th_percentile": 1962.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 3596.0, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 3596.0, "10th_percentile": 3596.0, "90th_percentile": 3596.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2954.98, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2954.98, "10th_percentile": 2954.98, "90th_percentile": 2954.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2184.96, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2184.96, "10th_percentile": 2184.96, "90th_percentile": 2184.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 3908.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2931.53, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2931.53, "10th_percentile": 2931.53, "90th_percentile": 2931.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1758.92, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1758.92, "10th_percentile": 1758.92, "90th_percentile": 1758.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 3048.79, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 3048.79, "10th_percentile": 3048.79, "90th_percentile": 3048.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 11.5% = $449.50 due to $0.00 Claim Price", "median_amount": 449.5, "10th_percentile": 449.5, "90th_percentile": 449.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 11.5% = $449.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 11.5% = $449.50 due to $0.00 Claim Price", "median_amount": 449.5, "10th_percentile": 449.5, "90th_percentile": 449.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,908.70 @ 11.5% = $449.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3908.7, "10th_percentile": 3908.7, "90th_percentile": 3908.7, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BASKET ZERO TIP NITINOL STONE RETRIEVAL 1.9FR M0063901050", "code_information": [ { "code": "SUP-104215", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 323.92, "maximum": 1770.06, "setting": "outpatient", "gross_charge": 1770.06, "discounted_cash": 1239.04, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1522.25, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1522.25, "10th_percentile": 1522.25, "90th_percentile": 1522.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1522.25, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1522.25, "10th_percentile": 1522.25, "90th_percentile": 1522.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1522.25, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1522.25, "10th_percentile": 1522.25, "90th_percentile": 1522.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1522.25, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1522.25, "10th_percentile": 1522.25, "90th_percentile": 1522.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1088.76, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1088.76, "10th_percentile": 1088.76, "90th_percentile": 1088.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1352.68, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1352.68, "10th_percentile": 1352.68, "90th_percentile": 1352.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 989.46, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 989.46, "10th_percentile": 989.46, "90th_percentile": 989.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1770.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1175.14, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1175.14, "10th_percentile": 1175.14, "90th_percentile": 1175.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1036.9, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1036.9, "10th_percentile": 1036.9, "90th_percentile": 1036.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1036.9, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1036.9, "10th_percentile": 1036.9, "90th_percentile": 1036.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 323.92, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 323.92, "10th_percentile": 323.92, "90th_percentile": 323.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 635.45, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 635.45, "10th_percentile": 635.45, "90th_percentile": 635.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1193.02, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1193.02, "10th_percentile": 1193.02, "90th_percentile": 1193.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 601.82, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 601.82, "10th_percentile": 601.82, "90th_percentile": 601.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1329.32, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1329.32, "10th_percentile": 1329.32, "90th_percentile": 1329.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1770.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1770.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1770.06, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1184.17, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1184.17, "10th_percentile": 1184.17, "90th_percentile": 1184.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1628.46, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1628.46, "10th_percentile": 1628.46, "90th_percentile": 1628.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 932.82, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 932.82, "10th_percentile": 932.82, "90th_percentile": 932.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 939.9, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 939.9, "10th_percentile": 939.9, "90th_percentile": 939.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1380.65, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1380.65, "10th_percentile": 1380.65, "90th_percentile": 1380.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 796.53, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 796.53, "10th_percentile": 796.53, "90th_percentile": 796.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1175.14, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1175.14, "10th_percentile": 1175.14, "90th_percentile": 1175.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1327.55, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1327.55, "10th_percentile": 1327.55, "90th_percentile": 1327.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1352.68, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1352.68, "10th_percentile": 1352.68, "90th_percentile": 1352.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1150.54, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1150.54, "10th_percentile": 1150.54, "90th_percentile": 1150.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 888.57, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 888.57, "10th_percentile": 888.57, "90th_percentile": 888.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1338.17, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1338.17, "10th_percentile": 1338.17, "90th_percentile": 1338.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1770.06, "10th_percentile": 1770.06, "90th_percentile": 1770.06, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 5137.63, "maximum": 13533.89, "setting": "inpatient", "gross_charge": 27814.5, "discounted_cash": 19470.15, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 23920.47, "10th_percentile": 23920.47, "90th_percentile": 23920.47, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 23920.47, "10th_percentile": 23920.47, "90th_percentile": 23920.47, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 23920.47, "10th_percentile": 23920.47, "90th_percentile": 23920.47, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 23920.47, "10th_percentile": 23920.47, "90th_percentile": 23920.47, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 27814.5, "10th_percentile": 27814.5, "90th_percentile": 27814.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 27814.5, "10th_percentile": 27814.5, "90th_percentile": 27814.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 27814.5, "10th_percentile": 27814.5, "90th_percentile": 27814.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services - OON; 100% Billed", "median_amount": 27814.5, "10th_percentile": 27814.5, "90th_percentile": 27814.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_percentage": 38.9, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; ALL INPATIENT; 38.9% Billed", "median_amount": 10819.84, "10th_percentile": 10819.84, "90th_percentile": 10819.84, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_percentage": 35.6, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All Inpatient Services; 35.6% Billed", "median_amount": 9901.96, "10th_percentile": 9901.96, "90th_percentile": 9901.96, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_percentage": 18.3, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 5090.06, "10th_percentile": 5090.06, "90th_percentile": 5090.06, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 12516.53, "10th_percentile": 12516.53, "90th_percentile": 12516.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_percentage": 92.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 25589.34, "10th_percentile": 25589.34, "90th_percentile": 25589.34, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_percentage": 76.1, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; 76.1% Billed", "median_amount": 21166.83, "10th_percentile": 21166.83, "90th_percentile": 21166.83, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; IP Services. ADP RATE (for patient estimates only); 49% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13629.11, "10th_percentile": 13629.11, "90th_percentile": 13629.11, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient Services; 75% Billed", "median_amount": 20860.88, "10th_percentile": 20860.88, "90th_percentile": 20860.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_percentage": 78.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 21695.31, "10th_percentile": 21695.31, "90th_percentile": 21695.31, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_dollar": 5137.63, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $6,358.14; Total: $6,358.14 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6358.14, "10th_percentile": 6358.14, "90th_percentile": 6358.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $6,358.14; Total: $6,358.14 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 5137.63, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $6,358.14; Total: $6,358.14", "median_amount": 6358.14, "10th_percentile": 6358.14, "90th_percentile": 6358.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $6,358.14; Total: $6,358.14" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 5137.63, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $6,358.14; Total: $6,358.14", "median_amount": 6358.14, "10th_percentile": 6358.14, "90th_percentile": 6358.14, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $6,358.14; Total: $6,358.14" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 10799.68, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10799.68, "10th_percentile": 10799.68, "90th_percentile": 10799.68, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 13533.89, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13533.89, "10th_percentile": 13533.89, "90th_percentile": 13533.89, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 9398.27, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 13,017.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE PREF STOP LOSS & LESSOR OF 9.*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9398.27, "10th_percentile": 9398.27, "90th_percentile": 9398.27, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 10799.68, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10799.68, "10th_percentile": 10799.68, "90th_percentile": 10799.68, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8950.63, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 12,397.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE SELECT STOP LOSS & LESSOR OF *; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8950.63, "10th_percentile": 8950.63, "90th_percentile": 8950.63, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 13533.89, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13533.89, "10th_percentile": 13533.89, "90th_percentile": 13533.89, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 10024.25, "standard_charge_algorithm": "Re-evaluated: HLB.759776235; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 13,884.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10024.25, "10th_percentile": 10024.25, "90th_percentile": 10024.25, "count": "1 through 10", "methodology": "case rate" } ] } ] }, { "description": "BERN 5F 0.038INX125CM CATH PERI DIAG 1SD PORT", "code_information": [ { "code": "SUP-355795", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 80.4, "maximum": 439.34, "setting": "outpatient", "gross_charge": 439.34, "discounted_cash": 307.54, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 377.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 377.83, "10th_percentile": 377.83, "90th_percentile": 377.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 377.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 377.83, "10th_percentile": 377.83, "90th_percentile": 377.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 377.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 377.83, "10th_percentile": 377.83, "90th_percentile": 377.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 377.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 377.83, "10th_percentile": 377.83, "90th_percentile": 377.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 270.24, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 270.24, "10th_percentile": 270.24, "90th_percentile": 270.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 335.74, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 335.74, "10th_percentile": 335.74, "90th_percentile": 335.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 245.59, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.59, "10th_percentile": 245.59, "90th_percentile": 245.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 439.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 291.68, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 291.68, "10th_percentile": 291.68, "90th_percentile": 291.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 257.37, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 257.37, "10th_percentile": 257.37, "90th_percentile": 257.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 257.37, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 257.37, "10th_percentile": 257.37, "90th_percentile": 257.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 80.4, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 80.4, "10th_percentile": 80.4, "90th_percentile": 80.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 157.72, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 157.72, "10th_percentile": 157.72, "90th_percentile": 157.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 296.12, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.12, "10th_percentile": 296.12, "90th_percentile": 296.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 149.38, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 149.38, "10th_percentile": 149.38, "90th_percentile": 149.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 329.94, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 329.94, "10th_percentile": 329.94, "90th_percentile": 329.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 439.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 439.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 439.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 293.92, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 293.92, "10th_percentile": 293.92, "90th_percentile": 293.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 404.19, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 404.19, "10th_percentile": 404.19, "90th_percentile": 404.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 231.53, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 231.53, "10th_percentile": 231.53, "90th_percentile": 231.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 233.29, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 233.29, "10th_percentile": 233.29, "90th_percentile": 233.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 342.69, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 342.69, "10th_percentile": 342.69, "90th_percentile": 342.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 197.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 197.7, "10th_percentile": 197.7, "90th_percentile": 197.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 291.68, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 291.68, "10th_percentile": 291.68, "90th_percentile": 291.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 329.51, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 329.51, "10th_percentile": 329.51, "90th_percentile": 329.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 335.74, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 335.74, "10th_percentile": 335.74, "90th_percentile": 335.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 285.57, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 285.57, "10th_percentile": 285.57, "90th_percentile": 285.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 220.55, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 220.55, "10th_percentile": 220.55, "90th_percentile": 220.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 332.14, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 332.14, "10th_percentile": 332.14, "90th_percentile": 332.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BETAMETHASONE DIPROPIONATE 0.05 % TOP CREA", "drug_information": { "unit": 15.0, "type": "GR" }, "code_information": [ { "code": "RX-1027", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00472-0380-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 43.97, "maximum": 240.25, "setting": "outpatient", "gross_charge": 240.25, "discounted_cash": 168.17, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 240.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 183.6, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 183.6, "10th_percentile": 183.6, "90th_percentile": 183.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 134.3, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.3, "10th_percentile": 134.3, "90th_percentile": 134.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 159.5, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 159.5, "10th_percentile": 159.5, "90th_percentile": 159.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 147.78, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 147.78, "10th_percentile": 147.78, "90th_percentile": 147.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 140.74, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.74, "10th_percentile": 140.74, "90th_percentile": 140.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 140.74, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 140.74, "10th_percentile": 140.74, "90th_percentile": 140.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 43.97, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 43.97, "10th_percentile": 43.97, "90th_percentile": 43.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 81.69, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 81.69, "10th_percentile": 81.69, "90th_percentile": 81.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 86.25, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 86.25, "10th_percentile": 86.25, "90th_percentile": 86.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 180.43, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.43, "10th_percentile": 180.43, "90th_percentile": 180.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 161.93, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 161.93, "10th_percentile": 161.93, "90th_percentile": 161.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 240.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 240.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 240.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 159.5, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 159.5, "10th_percentile": 159.5, "90th_percentile": 159.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 183.6, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 183.6, "10th_percentile": 183.6, "90th_percentile": 183.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 181.63, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 181.63, "10th_percentile": 181.63, "90th_percentile": 181.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 127.57, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 127.57, "10th_percentile": 127.57, "90th_percentile": 127.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 126.61, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 126.61, "10th_percentile": 126.61, "90th_percentile": 126.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 221.03, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 221.03, "10th_percentile": 221.03, "90th_percentile": 221.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 108.11, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 108.11, "10th_percentile": 108.11, "90th_percentile": 108.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 180.19, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 180.19, "10th_percentile": 180.19, "90th_percentile": 180.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 187.4, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 187.4, "10th_percentile": 187.4, "90th_percentile": 187.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 156.16, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 156.16, "10th_percentile": 156.16, "90th_percentile": 156.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 120.61, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 120.61, "10th_percentile": 120.61, "90th_percentile": 120.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 160.73, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 160.73, "10th_percentile": 160.73, "90th_percentile": 160.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 206.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 206.62, "10th_percentile": 206.62, "90th_percentile": 206.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 206.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 206.62, "10th_percentile": 206.62, "90th_percentile": 206.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 206.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 206.62, "10th_percentile": 206.62, "90th_percentile": 206.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 206.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 206.62, "10th_percentile": 206.62, "90th_percentile": 206.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 240.25, "10th_percentile": 240.25, "90th_percentile": 240.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIOPATCH DRESSING (4150)", "code_information": [ { "code": "SUP-304467", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 7.65, "maximum": 41.79, "setting": "outpatient", "gross_charge": 41.79, "discounted_cash": 29.25, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 35.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 35.94, "10th_percentile": 35.94, "90th_percentile": 35.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 35.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 35.94, "10th_percentile": 35.94, "90th_percentile": 35.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 35.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 35.94, "10th_percentile": 35.94, "90th_percentile": 35.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 35.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 35.94, "10th_percentile": 35.94, "90th_percentile": 35.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 25.71, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.71, "10th_percentile": 25.71, "90th_percentile": 25.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 31.94, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31.94, "10th_percentile": 31.94, "90th_percentile": 31.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 23.36, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.36, "10th_percentile": 23.36, "90th_percentile": 23.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 27.74, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 27.74, "10th_percentile": 27.74, "90th_percentile": 27.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 24.48, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.48, "10th_percentile": 24.48, "90th_percentile": 24.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 24.48, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.48, "10th_percentile": 24.48, "90th_percentile": 24.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 7.65, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 7.65, "10th_percentile": 7.65, "90th_percentile": 7.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 15.0, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 15.0, "10th_percentile": 15.0, "90th_percentile": 15.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 28.17, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.17, "10th_percentile": 28.17, "90th_percentile": 28.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 14.21, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 14.21, "10th_percentile": 14.21, "90th_percentile": 14.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 31.38, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31.38, "10th_percentile": 31.38, "90th_percentile": 31.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 41.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 41.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 27.96, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.96, "10th_percentile": 27.96, "90th_percentile": 27.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 38.45, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 38.45, "10th_percentile": 38.45, "90th_percentile": 38.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 22.02, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.02, "10th_percentile": 22.02, "90th_percentile": 22.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 22.19, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 22.19, "10th_percentile": 22.19, "90th_percentile": 22.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 32.6, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 32.6, "10th_percentile": 32.6, "90th_percentile": 32.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 18.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 18.81, "10th_percentile": 18.81, "90th_percentile": 18.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 27.74, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 27.74, "10th_percentile": 27.74, "90th_percentile": 27.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 31.34, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 31.34, "10th_percentile": 31.34, "90th_percentile": 31.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 31.94, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31.94, "10th_percentile": 31.94, "90th_percentile": 31.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 27.16, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 27.16, "10th_percentile": 27.16, "90th_percentile": 27.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 20.98, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.98, "10th_percentile": 20.98, "90th_percentile": 20.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 31.59, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 31.59, "10th_percentile": 31.59, "90th_percentile": 31.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 13227.62, "maximum": 34845.08, "setting": "inpatient", "gross_charge": 74139.14, "discounted_cash": 51897.4, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 63694.52, "10th_percentile": 63694.52, "90th_percentile": 63694.52, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 63694.52, "10th_percentile": 63694.52, "90th_percentile": 63694.52, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 63694.52, "10th_percentile": 63694.52, "90th_percentile": 63694.52, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_percentage": 86.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 63694.52, "10th_percentile": 63694.52, "90th_percentile": 63694.52, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 74063.39, "10th_percentile": 74063.39, "90th_percentile": 74063.39, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 74063.39, "10th_percentile": 74063.39, "90th_percentile": 74063.39, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 74063.39, "10th_percentile": 74063.39, "90th_percentile": 74063.39, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services - OON; 100% Billed", "median_amount": 72479.39, "10th_percentile": 72479.39, "90th_percentile": 72479.39, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_percentage": 38.9, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; ALL INPATIENT; 38.9% Billed", "median_amount": 28575.02, "10th_percentile": 28575.02, "90th_percentile": 28575.02, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_percentage": 35.6, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All Inpatient Services; 35.6% Billed", "median_amount": 26380.99, "10th_percentile": 26380.99, "90th_percentile": 26380.99, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_percentage": 18.3, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 13553.61, "10th_percentile": 13553.61, "90th_percentile": 13553.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 33328.53, "10th_percentile": 33328.53, "90th_percentile": 33328.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_percentage": 92.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 68138.32, "10th_percentile": 68138.32, "90th_percentile": 68138.32, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_percentage": 76.1, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; 76.1% Billed", "median_amount": 56338.19, "10th_percentile": 56338.19, "90th_percentile": 56338.19, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 49.0, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; IP Services. ADP RATE (for patient estimates only); 49% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36622.88, "10th_percentile": 36622.88, "90th_percentile": 36622.88, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient Services; 75% Billed", "median_amount": 55547.54, "10th_percentile": 55547.54, "90th_percentile": 55547.54, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_percentage": 78.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 57769.44, "10th_percentile": 57769.44, "90th_percentile": 57769.44, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_dollar": 13227.62, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $15,263.61; Total: $15,263.61 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15519.09, "10th_percentile": 15519.09, "90th_percentile": 15519.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $15,263.61; Total: $15,263.61 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 13227.62, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $15,263.61; Total: $15,263.61", "median_amount": 15519.09, "10th_percentile": 15519.09, "90th_percentile": 15519.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $15,263.61; Total: $15,263.61" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_dollar": 13227.62, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $15,263.61; Total: $15,263.61", "median_amount": 15519.09, "10th_percentile": 15519.09, "90th_percentile": 15519.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $15,263.61; Total: $15,263.61" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 27805.43, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.8589, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30998.13, "10th_percentile": 30998.13, "90th_percentile": 30998.13, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 34845.08, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.8589, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38185.89, "10th_percentile": 38185.89, "90th_percentile": 38185.89, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 24197.3, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.8589, Rate: 13,017.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE PREF STOP LOSS & LESSOR OF 9.*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27014.41, "10th_percentile": 27014.41, "90th_percentile": 27014.41, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 27805.43, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.8589, Rate: 14,958.00, and; Pricing Extension - NM HB XR PRC - KH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30998.13, "10th_percentile": 30998.13, "90th_percentile": 30998.13, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 23044.78, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.8589, Rate: 12,397.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE SELECT STOP LOSS & LESSOR OF *; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25861.89, "10th_percentile": 25861.89, "90th_percentile": 25861.89, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 34845.08, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.8589, Rate: 18,745.00, and; Pricing Extension - NM HB XR PRC - KH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38185.89, "10th_percentile": 38185.89, "90th_percentile": 38185.89, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 25808.97, "standard_charge_algorithm": "Re-evaluated: HLB.782091125; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.8589, Rate: 13,884.00, and; Pricing Extension - NM HB XR PRC - KH BCBS CHOICE STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28766.99, "10th_percentile": 28766.99, "90th_percentile": 28766.99, "count": "1 through 10", "methodology": "case rate" } ] } ] }, { "description": "BISACODYL 10 MG RECT SUPP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-1080", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "00574-7050-50", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.41, "maximum": 2.25, "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.52, "10th_percentile": 1.52, "90th_percentile": 1.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 0.81, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 0.77, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 0.77, "10th_percentile": 0.77, "90th_percentile": 0.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.41, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.41, "10th_percentile": 0.41, "90th_percentile": 0.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1.7, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1.7, "10th_percentile": 1.7, "90th_percentile": 1.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2.07, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2.07, "10th_percentile": 2.07, "90th_percentile": 2.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1.76, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1.76, "10th_percentile": 1.76, "90th_percentile": 1.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.51, "10th_percentile": 1.51, "90th_percentile": 1.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.26, "10th_percentile": 1.26, "90th_percentile": 1.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.6, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.6, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.36, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.36, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.36, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price", "median_amount": 0.26, "10th_percentile": 0.26, "90th_percentile": 0.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price", "median_amount": 0.26, "10th_percentile": 0.26, "90th_percentile": 0.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "RX-1090", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "37000-0032-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.41, "maximum": 2.25, "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.38, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.38, "10th_percentile": 1.38, "90th_percentile": 1.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.32, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.32, "10th_percentile": 1.32, "90th_percentile": 1.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.32, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.32, "10th_percentile": 1.32, "90th_percentile": 1.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.26, "10th_percentile": 1.26, "90th_percentile": 1.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.72, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.52, "10th_percentile": 1.52, "90th_percentile": 1.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 0.81, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 0.81, "10th_percentile": 0.81, "90th_percentile": 0.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 0.77, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 0.77, "10th_percentile": 0.77, "90th_percentile": 0.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.41, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.41, "10th_percentile": 0.41, "90th_percentile": 0.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.72, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1.7, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1.7, "10th_percentile": 1.7, "90th_percentile": 1.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1.19, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.19, "10th_percentile": 1.19, "90th_percentile": 1.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1.19, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.19, "10th_percentile": 1.19, "90th_percentile": 1.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2.07, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2.07, "10th_percentile": 2.07, "90th_percentile": 2.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1.69, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1.76, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1.76, "10th_percentile": 1.76, "90th_percentile": 1.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1.13, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.13, "10th_percentile": 1.13, "90th_percentile": 1.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1.51, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.51, "10th_percentile": 1.51, "90th_percentile": 1.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT 180114000 3/32 TWST DRILL", "code_information": [ { "code": "SUP-317476", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 130.22, "maximum": 711.6, "setting": "outpatient", "gross_charge": 711.6, "discounted_cash": 498.12, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 611.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 611.98, "10th_percentile": 611.98, "90th_percentile": 611.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 611.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 611.98, "10th_percentile": 611.98, "90th_percentile": 611.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 611.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 611.98, "10th_percentile": 611.98, "90th_percentile": 611.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 611.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 611.98, "10th_percentile": 611.98, "90th_percentile": 611.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 437.71, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.71, "10th_percentile": 437.71, "90th_percentile": 437.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 543.8, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 543.8, "10th_percentile": 543.8, "90th_percentile": 543.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 397.78, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 397.78, "10th_percentile": 397.78, "90th_percentile": 397.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 711.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 472.43, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 472.43, "10th_percentile": 472.43, "90th_percentile": 472.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 416.86, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 416.86, "10th_percentile": 416.86, "90th_percentile": 416.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 416.86, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 416.86, "10th_percentile": 416.86, "90th_percentile": 416.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 130.22, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 130.22, "10th_percentile": 130.22, "90th_percentile": 130.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 255.46, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 255.46, "10th_percentile": 255.46, "90th_percentile": 255.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 479.62, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 479.62, "10th_percentile": 479.62, "90th_percentile": 479.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 241.94, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 241.94, "10th_percentile": 241.94, "90th_percentile": 241.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 534.41, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 534.41, "10th_percentile": 534.41, "90th_percentile": 534.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 711.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 711.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 711.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 476.06, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 476.06, "10th_percentile": 476.06, "90th_percentile": 476.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 654.67, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 654.67, "10th_percentile": 654.67, "90th_percentile": 654.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 375.01, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 375.01, "10th_percentile": 375.01, "90th_percentile": 375.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 377.86, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 377.86, "10th_percentile": 377.86, "90th_percentile": 377.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 555.05, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 555.05, "10th_percentile": 555.05, "90th_percentile": 555.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 320.22, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 320.22, "10th_percentile": 320.22, "90th_percentile": 320.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 472.43, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 472.43, "10th_percentile": 472.43, "90th_percentile": 472.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 533.7, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 533.7, "10th_percentile": 533.7, "90th_percentile": 533.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 543.8, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 543.8, "10th_percentile": 543.8, "90th_percentile": 543.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 462.54, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 462.54, "10th_percentile": 462.54, "90th_percentile": 462.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 357.22, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 357.22, "10th_percentile": 357.22, "90th_percentile": 357.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 537.97, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 537.97, "10th_percentile": 537.97, "90th_percentile": 537.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 711.6, "10th_percentile": 711.6, "90th_percentile": 711.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 135MM 2.7 VOLT ADD ON QUICK CONNECT CALIBRATION", "code_information": [ { "code": "SUP-451156", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 257.96, "maximum": 1409.64, "setting": "outpatient", "gross_charge": 1409.64, "discounted_cash": 986.75, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1212.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1212.29, "10th_percentile": 1212.29, "90th_percentile": 1212.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1212.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1212.29, "10th_percentile": 1212.29, "90th_percentile": 1212.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1212.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1212.29, "10th_percentile": 1212.29, "90th_percentile": 1212.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1212.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1212.29, "10th_percentile": 1212.29, "90th_percentile": 1212.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 867.07, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 867.07, "10th_percentile": 867.07, "90th_percentile": 867.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1077.25, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1077.25, "10th_percentile": 1077.25, "90th_percentile": 1077.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 787.99, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 787.99, "10th_percentile": 787.99, "90th_percentile": 787.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1409.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 935.86, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 935.86, "10th_percentile": 935.86, "90th_percentile": 935.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 825.77, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 825.77, "10th_percentile": 825.77, "90th_percentile": 825.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 825.77, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 825.77, "10th_percentile": 825.77, "90th_percentile": 825.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 257.96, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 257.96, "10th_percentile": 257.96, "90th_percentile": 257.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 506.06, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 506.06, "10th_percentile": 506.06, "90th_percentile": 506.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 950.1, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 950.1, "10th_percentile": 950.1, "90th_percentile": 950.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 479.28, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 479.28, "10th_percentile": 479.28, "90th_percentile": 479.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1058.64, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1058.64, "10th_percentile": 1058.64, "90th_percentile": 1058.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1409.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1409.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1409.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 943.05, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 943.05, "10th_percentile": 943.05, "90th_percentile": 943.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1296.87, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1296.87, "10th_percentile": 1296.87, "90th_percentile": 1296.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 742.88, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 742.88, "10th_percentile": 742.88, "90th_percentile": 742.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 748.52, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 748.52, "10th_percentile": 748.52, "90th_percentile": 748.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1099.52, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1099.52, "10th_percentile": 1099.52, "90th_percentile": 1099.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 634.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 634.34, "10th_percentile": 634.34, "90th_percentile": 634.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 935.86, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 935.86, "10th_percentile": 935.86, "90th_percentile": 935.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1057.23, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1057.23, "10th_percentile": 1057.23, "90th_percentile": 1057.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1077.25, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1077.25, "10th_percentile": 1077.25, "90th_percentile": 1077.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 916.27, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 916.27, "10th_percentile": 916.27, "90th_percentile": 916.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 707.64, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 707.64, "10th_percentile": 707.64, "90th_percentile": 707.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1065.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1065.69, "10th_percentile": 1065.69, "90th_percentile": 1065.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1409.64, "10th_percentile": 1409.64, "90th_percentile": 1409.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 3.2MM STRL 321-52-07", "code_information": [ { "code": "SUP-344730", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 332.45, "maximum": 1816.66, "setting": "outpatient", "gross_charge": 1816.66, "discounted_cash": 1271.66, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1562.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1562.33, "10th_percentile": 1562.33, "90th_percentile": 1562.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1562.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1562.33, "10th_percentile": 1562.33, "90th_percentile": 1562.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1562.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1562.33, "10th_percentile": 1562.33, "90th_percentile": 1562.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1562.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1562.33, "10th_percentile": 1562.33, "90th_percentile": 1562.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1117.43, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1117.43, "10th_percentile": 1117.43, "90th_percentile": 1117.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1388.29, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1388.29, "10th_percentile": 1388.29, "90th_percentile": 1388.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1015.51, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1015.51, "10th_percentile": 1015.51, "90th_percentile": 1015.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1816.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1206.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1206.08, "10th_percentile": 1206.08, "90th_percentile": 1206.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1064.2, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1064.2, "10th_percentile": 1064.2, "90th_percentile": 1064.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1064.2, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1064.2, "10th_percentile": 1064.2, "90th_percentile": 1064.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 332.45, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 332.45, "10th_percentile": 332.45, "90th_percentile": 332.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 652.18, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 652.18, "10th_percentile": 652.18, "90th_percentile": 652.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1224.43, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1224.43, "10th_percentile": 1224.43, "90th_percentile": 1224.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 617.66, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 617.66, "10th_percentile": 617.66, "90th_percentile": 617.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1364.31, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1364.31, "10th_percentile": 1364.31, "90th_percentile": 1364.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1816.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1816.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1816.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1215.35, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1215.35, "10th_percentile": 1215.35, "90th_percentile": 1215.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1671.33, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1671.33, "10th_percentile": 1671.33, "90th_percentile": 1671.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 957.38, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 957.38, "10th_percentile": 957.38, "90th_percentile": 957.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 964.65, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 964.65, "10th_percentile": 964.65, "90th_percentile": 964.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1416.99, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1416.99, "10th_percentile": 1416.99, "90th_percentile": 1416.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 817.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 817.5, "10th_percentile": 817.5, "90th_percentile": 817.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1206.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1206.08, "10th_percentile": 1206.08, "90th_percentile": 1206.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1362.5, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1362.5, "10th_percentile": 1362.5, "90th_percentile": 1362.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1388.29, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1388.29, "10th_percentile": 1388.29, "90th_percentile": 1388.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1180.83, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1180.83, "10th_percentile": 1180.83, "90th_percentile": 1180.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 911.96, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 911.96, "10th_percentile": 911.96, "90th_percentile": 911.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1373.39, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1373.39, "10th_percentile": 1373.39, "90th_percentile": 1373.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1816.66, "10th_percentile": 1816.66, "90th_percentile": 1816.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 4.5/6.5MM 485MM TI STEPPED RECON 03.010.078", "code_information": [ { "code": "SUP-344359", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 570.4, "maximum": 3116.93, "setting": "outpatient", "gross_charge": 3116.93, "discounted_cash": 2181.85, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2680.56, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2680.56, "10th_percentile": 2680.56, "90th_percentile": 2680.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2680.56, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2680.56, "10th_percentile": 2680.56, "90th_percentile": 2680.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2680.56, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2680.56, "10th_percentile": 2680.56, "90th_percentile": 2680.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2680.56, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2680.56, "10th_percentile": 2680.56, "90th_percentile": 2680.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1917.22, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1917.22, "10th_percentile": 1917.22, "90th_percentile": 1917.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2381.96, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2381.96, "10th_percentile": 2381.96, "90th_percentile": 2381.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1742.36, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1742.36, "10th_percentile": 1742.36, "90th_percentile": 1742.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3116.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2069.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2069.33, "10th_percentile": 2069.33, "90th_percentile": 2069.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1825.9, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1825.9, "10th_percentile": 1825.9, "90th_percentile": 1825.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1825.9, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1825.9, "10th_percentile": 1825.9, "90th_percentile": 1825.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 570.4, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 570.4, "10th_percentile": 570.4, "90th_percentile": 570.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1118.98, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1118.98, "10th_percentile": 1118.98, "90th_percentile": 1118.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 2100.81, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2100.81, "10th_percentile": 2100.81, "90th_percentile": 2100.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1059.76, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1059.76, "10th_percentile": 1059.76, "90th_percentile": 1059.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 2340.81, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2340.81, "10th_percentile": 2340.81, "90th_percentile": 2340.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3116.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 3116.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3116.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 2085.23, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2085.23, "10th_percentile": 2085.23, "90th_percentile": 2085.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2867.58, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2867.58, "10th_percentile": 2867.58, "90th_percentile": 2867.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1642.62, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1642.62, "10th_percentile": 1642.62, "90th_percentile": 1642.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1655.09, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1655.09, "10th_percentile": 1655.09, "90th_percentile": 1655.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 2431.21, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 2431.21, "10th_percentile": 2431.21, "90th_percentile": 2431.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1402.62, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1402.62, "10th_percentile": 1402.62, "90th_percentile": 1402.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2069.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2069.33, "10th_percentile": 2069.33, "90th_percentile": 2069.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2337.7, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2337.7, "10th_percentile": 2337.7, "90th_percentile": 2337.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2381.96, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2381.96, "10th_percentile": 2381.96, "90th_percentile": 2381.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 2026.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 2026.0, "10th_percentile": 2026.0, "90th_percentile": 2026.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1564.7, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1564.7, "10th_percentile": 1564.7, "90th_percentile": 1564.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2356.4, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2356.4, "10th_percentile": 2356.4, "90th_percentile": 2356.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3116.93, "10th_percentile": 3116.93, "90th_percentile": 3116.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL TWST 5MM X 1/8IN SS", "code_information": [ { "code": "SUP-333240", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 66.71, "maximum": 364.53, "setting": "outpatient", "gross_charge": 364.53, "discounted_cash": 255.17, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 313.5, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 313.5, "10th_percentile": 313.5, "90th_percentile": 313.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 313.5, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 313.5, "10th_percentile": 313.5, "90th_percentile": 313.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 313.5, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 313.5, "10th_percentile": 313.5, "90th_percentile": 313.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 313.5, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 313.5, "10th_percentile": 313.5, "90th_percentile": 313.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 224.22, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.22, "10th_percentile": 224.22, "90th_percentile": 224.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 278.57, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 278.57, "10th_percentile": 278.57, "90th_percentile": 278.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 203.77, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 203.77, "10th_percentile": 203.77, "90th_percentile": 203.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 364.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 242.01, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 242.01, "10th_percentile": 242.01, "90th_percentile": 242.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 213.54, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 213.54, "10th_percentile": 213.54, "90th_percentile": 213.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 213.54, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 213.54, "10th_percentile": 213.54, "90th_percentile": 213.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 66.71, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 66.71, "10th_percentile": 66.71, "90th_percentile": 66.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 130.87, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 130.87, "10th_percentile": 130.87, "90th_percentile": 130.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 245.69, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 245.69, "10th_percentile": 245.69, "90th_percentile": 245.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 123.94, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 123.94, "10th_percentile": 123.94, "90th_percentile": 123.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 273.76, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273.76, "10th_percentile": 273.76, "90th_percentile": 273.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 364.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 364.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 364.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 243.87, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 243.87, "10th_percentile": 243.87, "90th_percentile": 243.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 335.37, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 335.37, "10th_percentile": 335.37, "90th_percentile": 335.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 192.11, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.11, "10th_percentile": 192.11, "90th_percentile": 192.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 193.57, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 193.57, "10th_percentile": 193.57, "90th_percentile": 193.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 284.33, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 284.33, "10th_percentile": 284.33, "90th_percentile": 284.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 164.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 164.04, "10th_percentile": 164.04, "90th_percentile": 164.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 242.01, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 242.01, "10th_percentile": 242.01, "90th_percentile": 242.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 273.4, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 273.4, "10th_percentile": 273.4, "90th_percentile": 273.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 278.57, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 278.57, "10th_percentile": 278.57, "90th_percentile": 278.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 236.94, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 236.94, "10th_percentile": 236.94, "90th_percentile": 236.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 182.99, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 182.99, "10th_percentile": 182.99, "90th_percentile": 182.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 275.58, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 275.58, "10th_percentile": 275.58, "90th_percentile": 275.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 364.53, "10th_percentile": 364.53, "90th_percentile": 364.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL ZIM 5/64\"", "code_information": [ { "code": "SUP-309215", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 68.98, "maximum": 376.95, "setting": "outpatient", "gross_charge": 376.95, "discounted_cash": 263.86, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 324.18, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 324.18, "10th_percentile": 324.18, "90th_percentile": 324.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 324.18, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 324.18, "10th_percentile": 324.18, "90th_percentile": 324.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 324.18, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 324.18, "10th_percentile": 324.18, "90th_percentile": 324.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 324.18, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 324.18, "10th_percentile": 324.18, "90th_percentile": 324.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 231.86, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 231.86, "10th_percentile": 231.86, "90th_percentile": 231.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 288.07, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 288.07, "10th_percentile": 288.07, "90th_percentile": 288.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 210.72, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 210.72, "10th_percentile": 210.72, "90th_percentile": 210.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 250.26, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 250.26, "10th_percentile": 250.26, "90th_percentile": 250.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 220.82, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 220.82, "10th_percentile": 220.82, "90th_percentile": 220.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 220.82, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 220.82, "10th_percentile": 220.82, "90th_percentile": 220.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 68.98, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 68.98, "10th_percentile": 68.98, "90th_percentile": 68.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 135.33, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 135.33, "10th_percentile": 135.33, "90th_percentile": 135.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 254.06, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 254.06, "10th_percentile": 254.06, "90th_percentile": 254.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 128.16, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 128.16, "10th_percentile": 128.16, "90th_percentile": 128.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 283.09, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 283.09, "10th_percentile": 283.09, "90th_percentile": 283.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 376.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 376.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 252.18, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 252.18, "10th_percentile": 252.18, "90th_percentile": 252.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 346.79, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 346.79, "10th_percentile": 346.79, "90th_percentile": 346.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 198.65, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 198.65, "10th_percentile": 198.65, "90th_percentile": 198.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 200.16, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 200.16, "10th_percentile": 200.16, "90th_percentile": 200.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 294.02, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 294.02, "10th_percentile": 294.02, "90th_percentile": 294.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 169.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 169.63, "10th_percentile": 169.63, "90th_percentile": 169.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 250.26, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 250.26, "10th_percentile": 250.26, "90th_percentile": 250.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 282.71, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 282.71, "10th_percentile": 282.71, "90th_percentile": 282.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 288.07, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 288.07, "10th_percentile": 288.07, "90th_percentile": 288.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 245.02, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 245.02, "10th_percentile": 245.02, "90th_percentile": 245.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 189.23, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.23, "10th_percentile": 189.23, "90th_percentile": 189.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 284.97, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 284.97, "10th_percentile": 284.97, "90th_percentile": 284.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.95, "10th_percentile": 376.95, "90th_percentile": 376.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRLL 215X5MM CNNLTD LG QCK CPLNG STRL", "code_information": [ { "code": "SUP-433849", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 639.38, "maximum": 3493.9, "setting": "outpatient", "gross_charge": 3493.9, "discounted_cash": 2445.73, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3004.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3004.75, "10th_percentile": 3004.75, "90th_percentile": 3004.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3004.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3004.75, "10th_percentile": 3004.75, "90th_percentile": 3004.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3004.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3004.75, "10th_percentile": 3004.75, "90th_percentile": 3004.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3004.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3004.75, "10th_percentile": 3004.75, "90th_percentile": 3004.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2149.1, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2149.1, "10th_percentile": 2149.1, "90th_percentile": 2149.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2670.04, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2670.04, "10th_percentile": 2670.04, "90th_percentile": 2670.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1953.09, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1953.09, "10th_percentile": 1953.09, "90th_percentile": 1953.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3493.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2319.6, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2319.6, "10th_percentile": 2319.6, "90th_percentile": 2319.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2046.73, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2046.73, "10th_percentile": 2046.73, "90th_percentile": 2046.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2046.73, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2046.73, "10th_percentile": 2046.73, "90th_percentile": 2046.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 639.38, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 639.38, "10th_percentile": 639.38, "90th_percentile": 639.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1254.31, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1254.31, "10th_percentile": 1254.31, "90th_percentile": 1254.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 2354.89, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2354.89, "10th_percentile": 2354.89, "90th_percentile": 2354.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1187.93, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1187.93, "10th_percentile": 1187.93, "90th_percentile": 1187.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 2623.92, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2623.92, "10th_percentile": 2623.92, "90th_percentile": 2623.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3493.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 3493.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3493.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 2337.42, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2337.42, "10th_percentile": 2337.42, "90th_percentile": 2337.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 3214.39, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 3214.39, "10th_percentile": 3214.39, "90th_percentile": 3214.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1841.29, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1841.29, "10th_percentile": 1841.29, "90th_percentile": 1841.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1855.26, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1855.26, "10th_percentile": 1855.26, "90th_percentile": 1855.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 2725.24, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 2725.24, "10th_percentile": 2725.24, "90th_percentile": 2725.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1572.26, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1572.26, "10th_percentile": 1572.26, "90th_percentile": 1572.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2319.6, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2319.6, "10th_percentile": 2319.6, "90th_percentile": 2319.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2620.43, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2620.43, "10th_percentile": 2620.43, "90th_percentile": 2620.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2670.04, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2670.04, "10th_percentile": 2670.04, "90th_percentile": 2670.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 2271.04, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 2271.04, "10th_percentile": 2271.04, "90th_percentile": 2271.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1753.94, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1753.94, "10th_percentile": 1753.94, "90th_percentile": 1753.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2641.39, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2641.39, "10th_percentile": 2641.39, "90th_percentile": 2641.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3493.9, "10th_percentile": 3493.9, "90th_percentile": 3493.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIVALIRUDIN 250 MG IV SOLR", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-29396", "type": "CDM" }, { "code": "J0583", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "63323-0562-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 95.11, "maximum": 519.75, "setting": "outpatient", "gross_charge": 519.75, "discounted_cash": 363.82, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 519.75, "10th_percentile": 519.75, "90th_percentile": 519.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 11.5% = $59.77 due to $0.00 Claim Price", "median_amount": 59.77, "10th_percentile": 59.77, "90th_percentile": 59.77, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 11.5% = $59.77 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 11.5% = $59.77 due to $0.00 Claim Price", "median_amount": 59.77, "10th_percentile": 59.77, "90th_percentile": 59.77, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 11.5% = $59.77 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.86, "10th_percentile": 35.86, "90th_percentile": 35.86, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.86, "10th_percentile": 35.86, "90th_percentile": 35.86, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.86, "10th_percentile": 35.86, "90th_percentile": 35.86, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.86, "10th_percentile": 35.86, "90th_percentile": 35.86, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.86, "10th_percentile": 35.86, "90th_percentile": 35.86, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.86, "10th_percentile": 35.86, "90th_percentile": 35.86, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.86, "10th_percentile": 35.86, "90th_percentile": 35.86, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $519.75 @ 6.9% = $35.86 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 519.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 519.75, "10th_percentile": 519.75, "90th_percentile": 519.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 290.54, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 290.54, "10th_percentile": 290.54, "90th_percentile": 290.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 392.93, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 392.93, "10th_percentile": 392.93, "90th_percentile": 392.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 233.89, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 233.89, "10th_percentile": 233.89, "90th_percentile": 233.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 519.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 519.75, "10th_percentile": 519.75, "90th_percentile": 519.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 478.17, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 478.17, "10th_percentile": 478.17, "90th_percentile": 478.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 186.59, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 186.59, "10th_percentile": 186.59, "90th_percentile": 186.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 95.11, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 95.11, "10th_percentile": 95.11, "90th_percentile": 95.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 176.72, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 176.72, "10th_percentile": 176.72, "90th_percentile": 176.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 389.81, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 389.81, "10th_percentile": 389.81, "90th_percentile": 389.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 405.41, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 405.41, "10th_percentile": 405.41, "90th_percentile": 405.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 369.02, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 369.02, "10th_percentile": 369.02, "90th_percentile": 369.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 369.02, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 369.02, "10th_percentile": 369.02, "90th_percentile": 369.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 519.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 519.75, "10th_percentile": 519.75, "90th_percentile": 519.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 519.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 519.75, "10th_percentile": 519.75, "90th_percentile": 519.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 345.06, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 345.06, "10th_percentile": 345.06, "90th_percentile": 345.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 345.06, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 345.06, "10th_percentile": 345.06, "90th_percentile": 345.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 313.93, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 313.93, "10th_percentile": 313.93, "90th_percentile": 313.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 313.93, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 313.93, "10th_percentile": 313.93, "90th_percentile": 313.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 313.93, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 313.93, "10th_percentile": 313.93, "90th_percentile": 313.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 446.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 446.99, "10th_percentile": 446.99, "90th_percentile": 446.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 446.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 446.99, "10th_percentile": 446.99, "90th_percentile": 446.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 446.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 446.99, "10th_percentile": 446.99, "90th_percentile": 446.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 446.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 446.99, "10th_percentile": 446.99, "90th_percentile": 446.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" } ] } ] }, { "description": "BLADE LIGHTED RETRACTOR BRITEFIELD WAVEGUDE 104015", "code_information": [ { "code": "SUP-353169", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 457.12, "maximum": 2497.91, "setting": "outpatient", "gross_charge": 2497.91, "discounted_cash": 1748.54, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2148.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2148.2, "10th_percentile": 2148.2, "90th_percentile": 2148.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2148.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2148.2, "10th_percentile": 2148.2, "90th_percentile": 2148.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2148.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2148.2, "10th_percentile": 2148.2, "90th_percentile": 2148.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2148.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2148.2, "10th_percentile": 2148.2, "90th_percentile": 2148.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1536.46, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1536.46, "10th_percentile": 1536.46, "90th_percentile": 1536.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1908.9, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1908.9, "10th_percentile": 1908.9, "90th_percentile": 1908.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1396.33, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1396.33, "10th_percentile": 1396.33, "90th_percentile": 1396.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2497.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1658.36, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1658.36, "10th_percentile": 1658.36, "90th_percentile": 1658.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1463.28, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1463.28, "10th_percentile": 1463.28, "90th_percentile": 1463.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1463.28, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1463.28, "10th_percentile": 1463.28, "90th_percentile": 1463.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 457.12, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 457.12, "10th_percentile": 457.12, "90th_percentile": 457.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 896.75, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 896.75, "10th_percentile": 896.75, "90th_percentile": 896.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1683.59, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1683.59, "10th_percentile": 1683.59, "90th_percentile": 1683.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 849.29, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 849.29, "10th_percentile": 849.29, "90th_percentile": 849.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1875.93, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1875.93, "10th_percentile": 1875.93, "90th_percentile": 1875.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2497.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2497.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2497.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1671.1, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1671.1, "10th_percentile": 1671.1, "90th_percentile": 1671.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2298.08, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2298.08, "10th_percentile": 2298.08, "90th_percentile": 2298.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1316.4, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1316.4, "10th_percentile": 1316.4, "90th_percentile": 1316.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1326.39, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1326.39, "10th_percentile": 1326.39, "90th_percentile": 1326.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1948.37, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1948.37, "10th_percentile": 1948.37, "90th_percentile": 1948.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1124.06, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1124.06, "10th_percentile": 1124.06, "90th_percentile": 1124.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1658.36, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1658.36, "10th_percentile": 1658.36, "90th_percentile": 1658.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1873.43, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1873.43, "10th_percentile": 1873.43, "90th_percentile": 1873.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1908.9, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1908.9, "10th_percentile": 1908.9, "90th_percentile": 1908.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1623.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1623.64, "10th_percentile": 1623.64, "90th_percentile": 1623.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1253.95, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1253.95, "10th_percentile": 1253.95, "90th_percentile": 1253.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1888.42, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1888.42, "10th_percentile": 1888.42, "90th_percentile": 1888.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2497.91, "10th_percentile": 2497.91, "90th_percentile": 2497.91, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLANKET INTOP UPPR BDY BAIR HGGR MUL-POSITION 78X24IN", "code_information": [ { "code": "SUP-337798", "type": "CDM" }, { "code": "27103350", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 15.23, "maximum": 83.24, "setting": "outpatient", "gross_charge": 83.24, "discounted_cash": 58.27, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 71.59, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 71.59, "10th_percentile": 71.59, "90th_percentile": 71.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 71.59, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 71.59, "10th_percentile": 71.59, "90th_percentile": 71.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 71.59, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 71.59, "10th_percentile": 71.59, "90th_percentile": 71.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 71.59, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 71.59, "10th_percentile": 71.59, "90th_percentile": 71.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 46.53, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 46.53, "10th_percentile": 46.53, "90th_percentile": 46.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 55.26, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 55.26, "10th_percentile": 55.26, "90th_percentile": 55.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 63.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63.61, "10th_percentile": 63.61, "90th_percentile": 63.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 51.2, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.2, "10th_percentile": 51.2, "90th_percentile": 51.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 48.76, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.76, "10th_percentile": 48.76, "90th_percentile": 48.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 48.76, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.76, "10th_percentile": 48.76, "90th_percentile": 48.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 56.1, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.1, "10th_percentile": 56.1, "90th_percentile": 56.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 62.51, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.51, "10th_percentile": 62.51, "90th_percentile": 62.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 29.88, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 29.88, "10th_percentile": 29.88, "90th_percentile": 29.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 28.3, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 28.3, "10th_percentile": 28.3, "90th_percentile": 28.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 15.23, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 15.23, "10th_percentile": 15.23, "90th_percentile": 15.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 83.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 83.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 62.93, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 62.93, "10th_percentile": 62.93, "90th_percentile": 62.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 55.69, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 55.69, "10th_percentile": 55.69, "90th_percentile": 55.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 54.11, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 54.11, "10th_percentile": 54.11, "90th_percentile": 54.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 76.58, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 76.58, "10th_percentile": 76.58, "90th_percentile": 76.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 44.2, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.2, "10th_percentile": 44.2, "90th_percentile": 44.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 55.26, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 55.26, "10th_percentile": 55.26, "90th_percentile": 55.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 41.79, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 41.79, "10th_percentile": 41.79, "90th_percentile": 41.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 37.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 37.46, "10th_percentile": 37.46, "90th_percentile": 37.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 43.87, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.87, "10th_percentile": 43.87, "90th_percentile": 43.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 63.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63.61, "10th_percentile": 63.61, "90th_percentile": 63.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 62.43, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 62.43, "10th_percentile": 62.43, "90th_percentile": 62.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 64.93, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 64.93, "10th_percentile": 64.93, "90th_percentile": 64.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.24, "10th_percentile": 83.24, "90th_percentile": 83.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLDE OSTEOTOM BNE THN 8MMX3IN", "code_information": [ { "code": "SUP-144464", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 515.3, "maximum": 2815.82, "setting": "outpatient", "gross_charge": 2815.82, "discounted_cash": 1971.07, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2421.61, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2421.61, "10th_percentile": 2421.61, "90th_percentile": 2421.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2421.61, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2421.61, "10th_percentile": 2421.61, "90th_percentile": 2421.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2421.61, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2421.61, "10th_percentile": 2421.61, "90th_percentile": 2421.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2421.61, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2421.61, "10th_percentile": 2421.61, "90th_percentile": 2421.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1732.01, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1732.01, "10th_percentile": 1732.01, "90th_percentile": 1732.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2151.85, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2151.85, "10th_percentile": 2151.85, "90th_percentile": 2151.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1574.04, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1574.04, "10th_percentile": 1574.04, "90th_percentile": 1574.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2815.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1869.42, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1869.42, "10th_percentile": 1869.42, "90th_percentile": 1869.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1649.51, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1649.51, "10th_percentile": 1649.51, "90th_percentile": 1649.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1649.51, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1649.51, "10th_percentile": 1649.51, "90th_percentile": 1649.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 515.3, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 515.3, "10th_percentile": 515.3, "90th_percentile": 515.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1010.88, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1010.88, "10th_percentile": 1010.88, "90th_percentile": 1010.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1897.86, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1897.86, "10th_percentile": 1897.86, "90th_percentile": 1897.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 957.38, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 957.38, "10th_percentile": 957.38, "90th_percentile": 957.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 2114.68, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2114.68, "10th_percentile": 2114.68, "90th_percentile": 2114.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2815.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2815.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2815.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1883.78, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1883.78, "10th_percentile": 1883.78, "90th_percentile": 1883.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2590.55, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2590.55, "10th_percentile": 2590.55, "90th_percentile": 2590.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1483.94, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1483.94, "10th_percentile": 1483.94, "90th_percentile": 1483.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1495.2, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1495.2, "10th_percentile": 1495.2, "90th_percentile": 1495.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 2196.34, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 2196.34, "10th_percentile": 2196.34, "90th_percentile": 2196.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1267.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1267.12, "10th_percentile": 1267.12, "90th_percentile": 1267.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1869.42, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1869.42, "10th_percentile": 1869.42, "90th_percentile": 1869.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2111.87, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2111.87, "10th_percentile": 2111.87, "90th_percentile": 2111.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2151.85, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2151.85, "10th_percentile": 2151.85, "90th_percentile": 2151.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1830.28, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1830.28, "10th_percentile": 1830.28, "90th_percentile": 1830.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1413.54, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1413.54, "10th_percentile": 1413.54, "90th_percentile": 1413.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2128.76, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2128.76, "10th_percentile": 2128.76, "90th_percentile": 2128.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2815.82, "10th_percentile": 2815.82, "90th_percentile": 2815.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLOCK CUT FEM MYKNEE R MED SZ 5", "code_information": [ { "code": "SUP-151728", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 124.67, "maximum": 681.25, "setting": "outpatient", "gross_charge": 681.25, "discounted_cash": 476.87, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 419.04, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 419.04, "10th_percentile": 419.04, "90th_percentile": 419.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 520.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 520.61, "10th_percentile": 520.61, "90th_percentile": 520.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 380.82, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 380.82, "10th_percentile": 380.82, "90th_percentile": 380.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 452.28, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 452.28, "10th_percentile": 452.28, "90th_percentile": 452.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 399.08, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 399.08, "10th_percentile": 399.08, "90th_percentile": 399.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 399.08, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 399.08, "10th_percentile": 399.08, "90th_percentile": 399.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 124.67, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 124.67, "10th_percentile": 124.67, "90th_percentile": 124.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 244.57, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 244.57, "10th_percentile": 244.57, "90th_percentile": 244.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 459.16, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 459.16, "10th_percentile": 459.16, "90th_percentile": 459.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 231.63, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 231.63, "10th_percentile": 231.63, "90th_percentile": 231.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 511.62, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 511.62, "10th_percentile": 511.62, "90th_percentile": 511.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 455.76, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 455.76, "10th_percentile": 455.76, "90th_percentile": 455.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 626.75, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 626.75, "10th_percentile": 626.75, "90th_percentile": 626.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 359.02, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 359.02, "10th_percentile": 359.02, "90th_percentile": 359.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 361.74, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 361.74, "10th_percentile": 361.74, "90th_percentile": 361.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 531.38, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 531.38, "10th_percentile": 531.38, "90th_percentile": 531.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 306.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 306.56, "10th_percentile": 306.56, "90th_percentile": 306.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 452.28, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 452.28, "10th_percentile": 452.28, "90th_percentile": 452.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 510.94, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 510.94, "10th_percentile": 510.94, "90th_percentile": 510.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 520.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 520.61, "10th_percentile": 520.61, "90th_percentile": 520.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 442.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 442.81, "10th_percentile": 442.81, "90th_percentile": 442.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 341.99, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 341.99, "10th_percentile": 341.99, "90th_percentile": 341.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 515.03, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 515.03, "10th_percentile": 515.03, "90th_percentile": 515.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLOCK CUT FEM MYKNEE R MED SZ 5+ 4.1025M", "code_information": [ { "code": "SUP-358390", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 124.67, "maximum": 681.25, "setting": "outpatient", "gross_charge": 681.25, "discounted_cash": 476.87, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 419.04, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 419.04, "10th_percentile": 419.04, "90th_percentile": 419.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 520.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 520.61, "10th_percentile": 520.61, "90th_percentile": 520.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 380.82, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 380.82, "10th_percentile": 380.82, "90th_percentile": 380.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 452.28, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 452.28, "10th_percentile": 452.28, "90th_percentile": 452.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 399.08, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 399.08, "10th_percentile": 399.08, "90th_percentile": 399.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 399.08, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 399.08, "10th_percentile": 399.08, "90th_percentile": 399.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 124.67, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 124.67, "10th_percentile": 124.67, "90th_percentile": 124.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 244.57, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 244.57, "10th_percentile": 244.57, "90th_percentile": 244.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 459.16, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 459.16, "10th_percentile": 459.16, "90th_percentile": 459.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 231.63, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 231.63, "10th_percentile": 231.63, "90th_percentile": 231.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 511.62, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 511.62, "10th_percentile": 511.62, "90th_percentile": 511.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 455.76, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 455.76, "10th_percentile": 455.76, "90th_percentile": 455.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 626.75, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 626.75, "10th_percentile": 626.75, "90th_percentile": 626.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 359.02, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 359.02, "10th_percentile": 359.02, "90th_percentile": 359.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 361.74, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 361.74, "10th_percentile": 361.74, "90th_percentile": 361.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 531.38, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 531.38, "10th_percentile": 531.38, "90th_percentile": 531.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 306.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 306.56, "10th_percentile": 306.56, "90th_percentile": 306.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 452.28, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 452.28, "10th_percentile": 452.28, "90th_percentile": 452.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 510.94, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 510.94, "10th_percentile": 510.94, "90th_percentile": 510.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 520.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 520.61, "10th_percentile": 520.61, "90th_percentile": 520.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 442.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 442.81, "10th_percentile": 442.81, "90th_percentile": 442.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 341.99, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 341.99, "10th_percentile": 341.99, "90th_percentile": 341.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 515.03, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 515.03, "10th_percentile": 515.03, "90th_percentile": 515.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLOCK CUT TIB MYKNEE R MED SZ 6", "code_information": [ { "code": "SUP-134702", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 124.67, "maximum": 681.25, "setting": "outpatient", "gross_charge": 681.25, "discounted_cash": 476.87, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 585.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 585.88, "10th_percentile": 585.88, "90th_percentile": 585.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 419.04, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 419.04, "10th_percentile": 419.04, "90th_percentile": 419.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 520.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 520.61, "10th_percentile": 520.61, "90th_percentile": 520.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 380.82, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 380.82, "10th_percentile": 380.82, "90th_percentile": 380.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 452.28, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 452.28, "10th_percentile": 452.28, "90th_percentile": 452.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 399.08, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 399.08, "10th_percentile": 399.08, "90th_percentile": 399.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 399.08, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 399.08, "10th_percentile": 399.08, "90th_percentile": 399.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 124.67, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 124.67, "10th_percentile": 124.67, "90th_percentile": 124.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 244.57, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 244.57, "10th_percentile": 244.57, "90th_percentile": 244.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 459.16, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 459.16, "10th_percentile": 459.16, "90th_percentile": 459.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 231.63, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 231.63, "10th_percentile": 231.63, "90th_percentile": 231.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 511.62, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 511.62, "10th_percentile": 511.62, "90th_percentile": 511.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 681.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 455.76, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 455.76, "10th_percentile": 455.76, "90th_percentile": 455.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 626.75, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 626.75, "10th_percentile": 626.75, "90th_percentile": 626.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 359.02, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 359.02, "10th_percentile": 359.02, "90th_percentile": 359.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 361.74, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 361.74, "10th_percentile": 361.74, "90th_percentile": 361.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 531.38, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 531.38, "10th_percentile": 531.38, "90th_percentile": 531.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 306.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 306.56, "10th_percentile": 306.56, "90th_percentile": 306.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 452.28, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 452.28, "10th_percentile": 452.28, "90th_percentile": 452.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 510.94, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 510.94, "10th_percentile": 510.94, "90th_percentile": 510.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 520.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 520.61, "10th_percentile": 520.61, "90th_percentile": 520.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 442.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 442.81, "10th_percentile": 442.81, "90th_percentile": 442.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 341.99, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 341.99, "10th_percentile": 341.99, "90th_percentile": 341.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 515.03, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 515.03, "10th_percentile": 515.03, "90th_percentile": 515.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 681.25, "10th_percentile": 681.25, "90th_percentile": 681.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BRIMONIDINE 0.2 % OPHT DROP", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-17881", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "24208-0411-05", "type": "NDC" } ], "standard_charges": [ { "minimum": 46.34, "maximum": 253.25, "setting": "outpatient", "gross_charge": 253.25, "discounted_cash": 177.27, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 127.13, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 127.13, "10th_percentile": 127.13, "90th_percentile": 127.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 164.61, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 164.61, "10th_percentile": 164.61, "90th_percentile": 164.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 168.13, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 168.13, "10th_percentile": 168.13, "90th_percentile": 168.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 193.53, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 193.53, "10th_percentile": 193.53, "90th_percentile": 193.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 232.99, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 232.99, "10th_percentile": 232.99, "90th_percentile": 232.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 197.54, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 197.54, "10th_percentile": 197.54, "90th_percentile": 197.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 134.48, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.48, "10th_percentile": 134.48, "90th_percentile": 134.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 133.46, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 133.46, "10th_percentile": 133.46, "90th_percentile": 133.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 113.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 113.96, "10th_percentile": 113.96, "90th_percentile": 113.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 189.94, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 189.94, "10th_percentile": 189.94, "90th_percentile": 189.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 169.42, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 169.42, "10th_percentile": 169.42, "90th_percentile": 169.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 191.46, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 191.46, "10th_percentile": 191.46, "90th_percentile": 191.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 253.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 253.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 253.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 46.34, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 46.34, "10th_percentile": 46.34, "90th_percentile": 46.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 86.11, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 86.11, "10th_percentile": 86.11, "90th_percentile": 86.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 90.92, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 90.92, "10th_percentile": 90.92, "90th_percentile": 90.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 190.19, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 190.19, "10th_percentile": 190.19, "90th_percentile": 190.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 170.69, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 170.69, "10th_percentile": 170.69, "90th_percentile": 170.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 155.77, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 155.77, "10th_percentile": 155.77, "90th_percentile": 155.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 168.13, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 168.13, "10th_percentile": 168.13, "90th_percentile": 168.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 253.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 193.53, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 193.53, "10th_percentile": 193.53, "90th_percentile": 193.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 141.57, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 141.57, "10th_percentile": 141.57, "90th_percentile": 141.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 148.35, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 148.35, "10th_percentile": 148.35, "90th_percentile": 148.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 148.35, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 148.35, "10th_percentile": 148.35, "90th_percentile": 148.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 217.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 217.8, "10th_percentile": 217.8, "90th_percentile": 217.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 217.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 217.8, "10th_percentile": 217.8, "90th_percentile": 217.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 217.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 217.8, "10th_percentile": 217.8, "90th_percentile": 217.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 217.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 217.8, "10th_percentile": 217.8, "90th_percentile": 217.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BRUSH BRONCH CYTO 5FRX120CM", "code_information": [ { "code": "SUP-320201", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 29.48, "maximum": 161.12, "setting": "outpatient", "gross_charge": 161.12, "discounted_cash": 112.78, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 138.56, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 138.56, "10th_percentile": 138.56, "90th_percentile": 138.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 138.56, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 138.56, "10th_percentile": 138.56, "90th_percentile": 138.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 138.56, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 138.56, "10th_percentile": 138.56, "90th_percentile": 138.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 138.56, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 138.56, "10th_percentile": 138.56, "90th_percentile": 138.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 99.1, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.1, "10th_percentile": 99.1, "90th_percentile": 99.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 123.13, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 123.13, "10th_percentile": 123.13, "90th_percentile": 123.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 90.07, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 90.07, "10th_percentile": 90.07, "90th_percentile": 90.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 161.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 106.97, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 106.97, "10th_percentile": 106.97, "90th_percentile": 106.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 94.38, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.38, "10th_percentile": 94.38, "90th_percentile": 94.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 94.38, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.38, "10th_percentile": 94.38, "90th_percentile": 94.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 29.48, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 29.48, "10th_percentile": 29.48, "90th_percentile": 29.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 57.84, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 57.84, "10th_percentile": 57.84, "90th_percentile": 57.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 108.59, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 108.59, "10th_percentile": 108.59, "90th_percentile": 108.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 54.78, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 54.78, "10th_percentile": 54.78, "90th_percentile": 54.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 121.0, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 121.0, "10th_percentile": 121.0, "90th_percentile": 121.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 161.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 161.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 161.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 107.79, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 107.79, "10th_percentile": 107.79, "90th_percentile": 107.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 148.23, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 148.23, "10th_percentile": 148.23, "90th_percentile": 148.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 84.91, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 84.91, "10th_percentile": 84.91, "90th_percentile": 84.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 85.55, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 85.55, "10th_percentile": 85.55, "90th_percentile": 85.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 125.67, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 125.67, "10th_percentile": 125.67, "90th_percentile": 125.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 72.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 72.5, "10th_percentile": 72.5, "90th_percentile": 72.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 106.97, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 106.97, "10th_percentile": 106.97, "90th_percentile": 106.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 120.84, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 120.84, "10th_percentile": 120.84, "90th_percentile": 120.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 123.13, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 123.13, "10th_percentile": 123.13, "90th_percentile": 123.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 104.73, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 104.73, "10th_percentile": 104.73, "90th_percentile": 104.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 80.88, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 80.88, "10th_percentile": 80.88, "90th_percentile": 80.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 121.81, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 121.81, "10th_percentile": 121.81, "90th_percentile": 121.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 161.12, "10th_percentile": 161.12, "90th_percentile": 161.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-92831", "type": "CDM" }, { "code": "J0665", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00409-1159-18", "type": "NDC" } ], "standard_charges": [ { "minimum": 12.81, "maximum": 70.0, "setting": "outpatient", "gross_charge": 70.0, "discounted_cash": 49.0, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 70.0, "10th_percentile": 70.0, "90th_percentile": 70.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 11.5% = $8.05 due to $0.00 Claim Price", "median_amount": 8.05, "10th_percentile": 8.05, "90th_percentile": 8.05, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 11.5% = $8.05 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 11.5% = $8.05 due to $0.00 Claim Price", "median_amount": 8.05, "10th_percentile": 8.05, "90th_percentile": 8.05, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 11.5% = $8.05 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.83, "10th_percentile": 4.83, "90th_percentile": 4.83, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $70.00 @ 6.9% = $4.83 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 60.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 60.2, "10th_percentile": 60.2, "90th_percentile": 60.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 60.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 60.2, "10th_percentile": 60.2, "90th_percentile": 60.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 60.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 60.2, "10th_percentile": 60.2, "90th_percentile": 60.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 60.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 60.2, "10th_percentile": 60.2, "90th_percentile": 60.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 42.28, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 42.28, "10th_percentile": 42.28, "90th_percentile": 42.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 42.28, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 42.28, "10th_percentile": 42.28, "90th_percentile": 42.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 42.28, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 42.28, "10th_percentile": 42.28, "90th_percentile": 42.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 70.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 70.0, "10th_percentile": 70.0, "90th_percentile": 70.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 70.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 70.0, "10th_percentile": 70.0, "90th_percentile": 70.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 46.47, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 46.47, "10th_percentile": 46.47, "90th_percentile": 46.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 46.47, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 46.47, "10th_percentile": 46.47, "90th_percentile": 46.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 49.7, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.7, "10th_percentile": 49.7, "90th_percentile": 49.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 49.7, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.7, "10th_percentile": 49.7, "90th_percentile": 49.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 12.81, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 12.81, "10th_percentile": 12.81, "90th_percentile": 12.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 23.8, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 23.8, "10th_percentile": 23.8, "90th_percentile": 23.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 25.13, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 25.13, "10th_percentile": 25.13, "90th_percentile": 25.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 70.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 70.0, "10th_percentile": 70.0, "90th_percentile": 70.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 52.92, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 52.92, "10th_percentile": 52.92, "90th_percentile": 52.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 52.5, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 52.5, "10th_percentile": 52.5, "90th_percentile": 52.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 70.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 70.0, "10th_percentile": 70.0, "90th_percentile": 70.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 64.4, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 64.4, "10th_percentile": 64.4, "90th_percentile": 64.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 31.5, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 54.6, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 54.6, "10th_percentile": 54.6, "90th_percentile": 54.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 39.13, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.13, "10th_percentile": 39.13, "90th_percentile": 39.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-92832", "type": "CDM" }, { "code": "J0665", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00143-9331-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 7.91, "maximum": 43.25, "setting": "outpatient", "gross_charge": 43.25, "discounted_cash": 30.27, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 43.25, "10th_percentile": 43.25, "90th_percentile": 43.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 11.5% = $4.97 due to $0.00 Claim Price", "median_amount": 4.97, "10th_percentile": 4.97, "90th_percentile": 4.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 11.5% = $4.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 11.5% = $4.97 due to $0.00 Claim Price", "median_amount": 4.97, "10th_percentile": 4.97, "90th_percentile": 4.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 11.5% = $4.97 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.98, "10th_percentile": 2.98, "90th_percentile": 2.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.98, "10th_percentile": 2.98, "90th_percentile": 2.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.98, "10th_percentile": 2.98, "90th_percentile": 2.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.98, "10th_percentile": 2.98, "90th_percentile": 2.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.98, "10th_percentile": 2.98, "90th_percentile": 2.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.98, "10th_percentile": 2.98, "90th_percentile": 2.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.98, "10th_percentile": 2.98, "90th_percentile": 2.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43.25 @ 6.9% = $2.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 37.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 37.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 37.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 37.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 26.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.12, "10th_percentile": 26.12, "90th_percentile": 26.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 26.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.12, "10th_percentile": 26.12, "90th_percentile": 26.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 26.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.12, "10th_percentile": 26.12, "90th_percentile": 26.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 43.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 43.25, "10th_percentile": 43.25, "90th_percentile": 43.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 43.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 43.25, "10th_percentile": 43.25, "90th_percentile": 43.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 28.71, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 28.71, "10th_percentile": 28.71, "90th_percentile": 28.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 28.71, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 28.71, "10th_percentile": 28.71, "90th_percentile": 28.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 30.71, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.71, "10th_percentile": 30.71, "90th_percentile": 30.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 30.71, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.71, "10th_percentile": 30.71, "90th_percentile": 30.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 7.91, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 7.91, "10th_percentile": 7.91, "90th_percentile": 7.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 14.71, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 14.71, "10th_percentile": 14.71, "90th_percentile": 14.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 15.53, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 15.53, "10th_percentile": 15.53, "90th_percentile": 15.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 43.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 43.25, "10th_percentile": 43.25, "90th_percentile": 43.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 32.7, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 32.7, "10th_percentile": 32.7, "90th_percentile": 32.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 32.44, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 32.44, "10th_percentile": 32.44, "90th_percentile": 32.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 43.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 43.25, "10th_percentile": 43.25, "90th_percentile": 43.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 39.79, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 39.79, "10th_percentile": 39.79, "90th_percentile": 39.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 19.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 19.46, "10th_percentile": 19.46, "90th_percentile": 19.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 33.74, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 33.74, "10th_percentile": 33.74, "90th_percentile": 33.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 24.18, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.18, "10th_percentile": 24.18, "90th_percentile": 24.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-92832", "type": "CDM" }, { "code": "J0665", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00409-1162-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 15.69, "maximum": 85.75, "setting": "outpatient", "gross_charge": 85.75, "discounted_cash": 60.02, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.75, "10th_percentile": 85.75, "90th_percentile": 85.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 11.5% = $9.86 due to $0.00 Claim Price", "median_amount": 9.86, "10th_percentile": 9.86, "90th_percentile": 9.86, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 11.5% = $9.86 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 11.5% = $9.86 due to $0.00 Claim Price", "median_amount": 9.86, "10th_percentile": 9.86, "90th_percentile": 9.86, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 11.5% = $9.86 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.92, "10th_percentile": 5.92, "90th_percentile": 5.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.92, "10th_percentile": 5.92, "90th_percentile": 5.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.92, "10th_percentile": 5.92, "90th_percentile": 5.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.92, "10th_percentile": 5.92, "90th_percentile": 5.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.92, "10th_percentile": 5.92, "90th_percentile": 5.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.92, "10th_percentile": 5.92, "90th_percentile": 5.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.92, "10th_percentile": 5.92, "90th_percentile": 5.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85.75 @ 6.9% = $5.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 73.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 73.75, "10th_percentile": 73.75, "90th_percentile": 73.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 73.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 73.75, "10th_percentile": 73.75, "90th_percentile": 73.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 73.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 73.75, "10th_percentile": 73.75, "90th_percentile": 73.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 73.75, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 73.75, "10th_percentile": 73.75, "90th_percentile": 73.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 51.79, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.79, "10th_percentile": 51.79, "90th_percentile": 51.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 51.79, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.79, "10th_percentile": 51.79, "90th_percentile": 51.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 51.79, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.79, "10th_percentile": 51.79, "90th_percentile": 51.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 85.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 85.75, "10th_percentile": 85.75, "90th_percentile": 85.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 85.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 85.75, "10th_percentile": 85.75, "90th_percentile": 85.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 56.93, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 56.93, "10th_percentile": 56.93, "90th_percentile": 56.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 56.93, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 56.93, "10th_percentile": 56.93, "90th_percentile": 56.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 60.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.88, "10th_percentile": 60.88, "90th_percentile": 60.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 60.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.88, "10th_percentile": 60.88, "90th_percentile": 60.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 15.69, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 15.69, "10th_percentile": 15.69, "90th_percentile": 15.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 29.16, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 29.16, "10th_percentile": 29.16, "90th_percentile": 29.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 30.78, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 30.78, "10th_percentile": 30.78, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 85.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 85.75, "10th_percentile": 85.75, "90th_percentile": 85.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 64.83, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 64.83, "10th_percentile": 64.83, "90th_percentile": 64.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 64.31, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 64.31, "10th_percentile": 64.31, "90th_percentile": 64.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 85.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 85.75, "10th_percentile": 85.75, "90th_percentile": 85.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 78.89, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 78.89, "10th_percentile": 78.89, "90th_percentile": 78.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 38.59, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 38.59, "10th_percentile": 38.59, "90th_percentile": 38.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 66.89, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 66.89, "10th_percentile": 66.89, "90th_percentile": 66.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 47.93, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 47.93, "10th_percentile": 47.93, "90th_percentile": 47.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "RX-92830", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "00409-9042-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 47.26, "maximum": 258.25, "setting": "outpatient", "gross_charge": 258.25, "discounted_cash": 180.77, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 222.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 222.1, "10th_percentile": 222.1, "90th_percentile": 222.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 222.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 222.1, "10th_percentile": 222.1, "90th_percentile": 222.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 222.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 222.1, "10th_percentile": 222.1, "90th_percentile": 222.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 222.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 222.1, "10th_percentile": 222.1, "90th_percentile": 222.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 158.85, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 158.85, "10th_percentile": 158.85, "90th_percentile": 158.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 151.28, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 151.28, "10th_percentile": 151.28, "90th_percentile": 151.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 151.28, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 151.28, "10th_percentile": 151.28, "90th_percentile": 151.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 171.45, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 171.45, "10th_percentile": 171.45, "90th_percentile": 171.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 144.36, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 144.36, "10th_percentile": 144.36, "90th_percentile": 144.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 197.35, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.35, "10th_percentile": 197.35, "90th_percentile": 197.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 174.06, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 174.06, "10th_percentile": 174.06, "90th_percentile": 174.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 193.95, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 193.95, "10th_percentile": 193.95, "90th_percentile": 193.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 92.71, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 92.71, "10th_percentile": 92.71, "90th_percentile": 92.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 87.81, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 87.81, "10th_percentile": 87.81, "90th_percentile": 87.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 47.26, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 47.26, "10th_percentile": 47.26, "90th_percentile": 47.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 171.45, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 171.45, "10th_percentile": 171.45, "90th_percentile": 171.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 197.35, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 197.35, "10th_percentile": 197.35, "90th_percentile": 197.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 195.24, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 195.24, "10th_percentile": 195.24, "90th_percentile": 195.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 137.13, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 137.13, "10th_percentile": 137.13, "90th_percentile": 137.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 136.1, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 136.1, "10th_percentile": 136.1, "90th_percentile": 136.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 237.59, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 237.59, "10th_percentile": 237.59, "90th_percentile": 237.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 116.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 116.21, "10th_percentile": 116.21, "90th_percentile": 116.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 193.69, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 193.69, "10th_percentile": 193.69, "90th_percentile": 193.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 201.44, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 201.44, "10th_percentile": 201.44, "90th_percentile": 201.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 167.86, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 167.86, "10th_percentile": 167.86, "90th_percentile": 167.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 129.64, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 129.64, "10th_percentile": 129.64, "90th_percentile": 129.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 172.77, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 172.77, "10th_percentile": 172.77, "90th_percentile": 172.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 258.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-92830", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "63323-0468-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 27.4, "maximum": 149.75, "setting": "outpatient", "gross_charge": 149.75, "discounted_cash": 104.82, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 128.79, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 128.79, "10th_percentile": 128.79, "90th_percentile": 128.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 128.79, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 128.79, "10th_percentile": 128.79, "90th_percentile": 128.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 128.79, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 128.79, "10th_percentile": 128.79, "90th_percentile": 128.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 128.79, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 128.79, "10th_percentile": 128.79, "90th_percentile": 128.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 87.72, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.72, "10th_percentile": 87.72, "90th_percentile": 87.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 87.72, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 87.72, "10th_percentile": 87.72, "90th_percentile": 87.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 149.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 92.11, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 92.11, "10th_percentile": 92.11, "90th_percentile": 92.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 99.42, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 99.42, "10th_percentile": 99.42, "90th_percentile": 99.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 83.71, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 83.71, "10th_percentile": 83.71, "90th_percentile": 83.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 114.44, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 114.44, "10th_percentile": 114.44, "90th_percentile": 114.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 100.93, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 100.93, "10th_percentile": 100.93, "90th_percentile": 100.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 112.46, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 112.46, "10th_percentile": 112.46, "90th_percentile": 112.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 53.76, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 53.76, "10th_percentile": 53.76, "90th_percentile": 53.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 50.92, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 50.92, "10th_percentile": 50.92, "90th_percentile": 50.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 27.4, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 27.4, "10th_percentile": 27.4, "90th_percentile": 27.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 99.42, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 99.42, "10th_percentile": 99.42, "90th_percentile": 99.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 114.44, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 114.44, "10th_percentile": 114.44, "90th_percentile": 114.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 113.21, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 113.21, "10th_percentile": 113.21, "90th_percentile": 113.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 79.52, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 79.52, "10th_percentile": 79.52, "90th_percentile": 79.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 78.92, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.92, "10th_percentile": 78.92, "90th_percentile": 78.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 137.77, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 137.77, "10th_percentile": 137.77, "90th_percentile": 137.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 67.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 67.39, "10th_percentile": 67.39, "90th_percentile": 67.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 112.31, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 112.31, "10th_percentile": 112.31, "90th_percentile": 112.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 116.81, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 116.81, "10th_percentile": 116.81, "90th_percentile": 116.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 149.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 97.34, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 97.34, "10th_percentile": 97.34, "90th_percentile": 97.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 75.17, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 75.17, "10th_percentile": 75.17, "90th_percentile": 75.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 100.18, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 100.18, "10th_percentile": 100.18, "90th_percentile": 100.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 149.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 149.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 149.75, "10th_percentile": 149.75, "90th_percentile": 149.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-92828", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "63323-0462-03", "type": "NDC" } ], "standard_charges": [ { "minimum": 15.56, "maximum": 85.0, "setting": "outpatient", "gross_charge": 85.0, "discounted_cash": 59.5, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 73.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 73.1, "10th_percentile": 73.1, "90th_percentile": 73.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 73.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 73.1, "10th_percentile": 73.1, "90th_percentile": 73.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 73.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 73.1, "10th_percentile": 73.1, "90th_percentile": 73.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 73.1, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 73.1, "10th_percentile": 73.1, "90th_percentile": 73.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 49.79, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.79, "10th_percentile": 49.79, "90th_percentile": 49.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 49.79, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.79, "10th_percentile": 49.79, "90th_percentile": 49.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 85.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 52.28, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 52.28, "10th_percentile": 52.28, "90th_percentile": 52.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 56.43, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 56.43, "10th_percentile": 56.43, "90th_percentile": 56.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 47.52, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 47.52, "10th_percentile": 47.52, "90th_percentile": 47.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 64.96, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 64.96, "10th_percentile": 64.96, "90th_percentile": 64.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 85.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 57.29, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.29, "10th_percentile": 57.29, "90th_percentile": 57.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 63.84, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63.84, "10th_percentile": 63.84, "90th_percentile": 63.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 30.52, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 30.52, "10th_percentile": 30.52, "90th_percentile": 30.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 28.9, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 28.9, "10th_percentile": 28.9, "90th_percentile": 28.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 15.56, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 15.56, "10th_percentile": 15.56, "90th_percentile": 15.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 56.43, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 56.43, "10th_percentile": 56.43, "90th_percentile": 56.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 64.96, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 64.96, "10th_percentile": 64.96, "90th_percentile": 64.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 64.26, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 64.26, "10th_percentile": 64.26, "90th_percentile": 64.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 45.14, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.14, "10th_percentile": 45.14, "90th_percentile": 45.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 44.8, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.8, "10th_percentile": 44.8, "90th_percentile": 44.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 78.2, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 78.2, "10th_percentile": 78.2, "90th_percentile": 78.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 38.25, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 38.25, "10th_percentile": 38.25, "90th_percentile": 38.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 63.75, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 63.75, "10th_percentile": 63.75, "90th_percentile": 63.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 66.3, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 66.3, "10th_percentile": 66.3, "90th_percentile": 66.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 85.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 55.25, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 55.25, "10th_percentile": 55.25, "90th_percentile": 55.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 42.67, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 42.67, "10th_percentile": 42.67, "90th_percentile": 42.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 56.87, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.87, "10th_percentile": 56.87, "90th_percentile": 56.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 85.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 85.0, "10th_percentile": 85.0, "90th_percentile": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "BUPRENORPHINE HCL 2 MG SL SUBL", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-92462", "type": "CDM" }, { "code": "J0571", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "62756-0459-83", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.7, "maximum": 14.75, "setting": "outpatient", "gross_charge": 14.75, "discounted_cash": 10.32, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.02, "10th_percentile": 1.02, "90th_percentile": 1.02, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 6.9% = $1.02 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 11.5% = $1.70 due to $0.00 Claim Price", "median_amount": 1.7, "10th_percentile": 1.7, "90th_percentile": 1.7, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 11.5% = $1.70 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 11.5% = $1.70 due to $0.00 Claim Price", "median_amount": 1.7, "10th_percentile": 1.7, "90th_percentile": 1.7, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 11.5% = $1.70 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 5.3, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 5.3, "10th_percentile": 5.3, "90th_percentile": 5.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 5.02, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 5.02, "10th_percentile": 5.02, "90th_percentile": 5.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 2.7, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 2.7, "10th_percentile": 2.7, "90th_percentile": 2.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9.79, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9.79, "10th_percentile": 9.79, "90th_percentile": 9.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10.47, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.47, "10th_percentile": 10.47, "90th_percentile": 10.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 8.91, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.91, "10th_percentile": 8.91, "90th_percentile": 8.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8.91, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.91, "10th_percentile": 8.91, "90th_percentile": 8.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8.91, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.91, "10th_percentile": 8.91, "90th_percentile": 8.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9.79, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9.79, "10th_percentile": 9.79, "90th_percentile": 9.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 8.25, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10.47, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.47, "10th_percentile": 10.47, "90th_percentile": 10.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 11.15, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 11.15, "10th_percentile": 11.15, "90th_percentile": 11.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 13.57, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 13.57, "10th_percentile": 13.57, "90th_percentile": 13.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 6.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 6.64, "10th_percentile": 6.64, "90th_percentile": 6.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 11.06, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 11.06, "10th_percentile": 11.06, "90th_percentile": 11.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 11.51, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 11.51, "10th_percentile": 11.51, "90th_percentile": 11.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 9.59, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 9.59, "10th_percentile": 9.59, "90th_percentile": 9.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 7.4, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7.4, "10th_percentile": 7.4, "90th_percentile": 7.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 9.87, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.87, "10th_percentile": 9.87, "90th_percentile": 9.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12.69, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12.69, "10th_percentile": 12.69, "90th_percentile": 12.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12.69, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12.69, "10th_percentile": 12.69, "90th_percentile": 12.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12.69, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12.69, "10th_percentile": 12.69, "90th_percentile": 12.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12.69, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12.69, "10th_percentile": 12.69, "90th_percentile": 12.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" } ] } ] }, { "description": "BUPRENORPHINE-NALOXONE 2-0.5 MG SL FILM", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-184165", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "43598-0579-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 18.57, "maximum": 101.5, "setting": "outpatient", "gross_charge": 101.5, "discounted_cash": 71.05, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 87.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 87.29, "10th_percentile": 87.29, "90th_percentile": 87.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 87.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 87.29, "10th_percentile": 87.29, "90th_percentile": 87.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 87.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 87.29, "10th_percentile": 87.29, "90th_percentile": 87.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 87.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 87.29, "10th_percentile": 87.29, "90th_percentile": 87.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 59.46, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.46, "10th_percentile": 59.46, "90th_percentile": 59.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 59.46, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.46, "10th_percentile": 59.46, "90th_percentile": 59.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 67.39, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 67.39, "10th_percentile": 67.39, "90th_percentile": 67.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 101.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 62.43, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.43, "10th_percentile": 62.43, "90th_percentile": 62.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 56.74, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.74, "10th_percentile": 56.74, "90th_percentile": 56.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 77.57, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.57, "10th_percentile": 77.57, "90th_percentile": 77.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 36.44, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 36.44, "10th_percentile": 36.44, "90th_percentile": 36.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 18.57, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 18.57, "10th_percentile": 18.57, "90th_percentile": 18.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 76.23, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 76.23, "10th_percentile": 76.23, "90th_percentile": 76.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 68.41, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.41, "10th_percentile": 68.41, "90th_percentile": 68.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 34.51, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 34.51, "10th_percentile": 34.51, "90th_percentile": 34.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 101.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 101.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 101.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 53.9, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.9, "10th_percentile": 53.9, "90th_percentile": 53.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 50.95, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.95, "10th_percentile": 50.95, "90th_percentile": 50.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 65.98, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 65.98, "10th_percentile": 65.98, "90th_percentile": 65.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 45.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 45.68, "10th_percentile": 45.68, "90th_percentile": 45.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 76.13, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 76.13, "10th_percentile": 76.13, "90th_percentile": 76.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 79.17, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 79.17, "10th_percentile": 79.17, "90th_percentile": 79.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 76.73, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 76.73, "10th_percentile": 76.73, "90th_percentile": 76.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 67.39, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 67.39, "10th_percentile": 67.39, "90th_percentile": 67.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 53.49, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.49, "10th_percentile": 53.49, "90th_percentile": 53.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 67.9, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.9, "10th_percentile": 67.9, "90th_percentile": 67.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 93.38, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 93.38, "10th_percentile": 93.38, "90th_percentile": 93.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 77.57, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.57, "10th_percentile": 77.57, "90th_percentile": 77.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "BUPRENORPHINE-NALOXONE 2-0.5 MG SL FILM", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-184165", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "43598-0579-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 18.57, "maximum": 101.5, "setting": "outpatient", "gross_charge": 101.5, "discounted_cash": 71.05, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 87.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 87.29, "10th_percentile": 87.29, "90th_percentile": 87.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 87.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 87.29, "10th_percentile": 87.29, "90th_percentile": 87.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 87.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 87.29, "10th_percentile": 87.29, "90th_percentile": 87.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 87.29, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 87.29, "10th_percentile": 87.29, "90th_percentile": 87.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 59.46, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.46, "10th_percentile": 59.46, "90th_percentile": 59.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 59.46, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 59.46, "10th_percentile": 59.46, "90th_percentile": 59.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 67.39, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 67.39, "10th_percentile": 67.39, "90th_percentile": 67.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 101.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 62.43, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.43, "10th_percentile": 62.43, "90th_percentile": 62.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 56.74, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.74, "10th_percentile": 56.74, "90th_percentile": 56.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 77.57, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.57, "10th_percentile": 77.57, "90th_percentile": 77.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 36.44, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 36.44, "10th_percentile": 36.44, "90th_percentile": 36.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 18.57, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 18.57, "10th_percentile": 18.57, "90th_percentile": 18.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 76.23, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 76.23, "10th_percentile": 76.23, "90th_percentile": 76.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 68.41, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.41, "10th_percentile": 68.41, "90th_percentile": 68.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 34.51, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 34.51, "10th_percentile": 34.51, "90th_percentile": 34.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 101.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 101.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 101.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 101.5, "10th_percentile": 101.5, "90th_percentile": 101.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 53.9, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.9, "10th_percentile": 53.9, "90th_percentile": 53.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 50.95, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.95, "10th_percentile": 50.95, "90th_percentile": 50.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 65.98, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 65.98, "10th_percentile": 65.98, "90th_percentile": 65.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 45.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 45.68, "10th_percentile": 45.68, "90th_percentile": 45.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 76.13, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 76.13, "10th_percentile": 76.13, "90th_percentile": 76.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 79.17, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 79.17, "10th_percentile": 79.17, "90th_percentile": 79.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 76.73, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 76.73, "10th_percentile": 76.73, "90th_percentile": 76.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 67.39, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 67.39, "10th_percentile": 67.39, "90th_percentile": 67.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 53.49, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.49, "10th_percentile": 53.49, "90th_percentile": 53.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 67.9, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.9, "10th_percentile": 67.9, "90th_percentile": 67.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 93.38, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 93.38, "10th_percentile": 93.38, "90th_percentile": 93.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 77.57, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.57, "10th_percentile": 77.57, "90th_percentile": 77.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "BUPRENORPHINE-NALOXONE 8-2 MG SL FILM", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-184166", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "43598-0582-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 15.83, "maximum": 86.5, "setting": "outpatient", "gross_charge": 86.5, "discounted_cash": 60.55, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 74.39, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 74.39, "10th_percentile": 74.39, "90th_percentile": 74.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 74.39, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 74.39, "10th_percentile": 74.39, "90th_percentile": 74.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 74.39, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 74.39, "10th_percentile": 74.39, "90th_percentile": 74.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 74.39, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 74.39, "10th_percentile": 74.39, "90th_percentile": 74.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 50.67, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.67, "10th_percentile": 50.67, "90th_percentile": 50.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 50.67, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.67, "10th_percentile": 50.67, "90th_percentile": 50.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 57.43, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 57.43, "10th_percentile": 57.43, "90th_percentile": 57.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 86.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 53.21, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.21, "10th_percentile": 53.21, "90th_percentile": 53.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 48.35, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.35, "10th_percentile": 48.35, "90th_percentile": 48.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 66.1, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 66.1, "10th_percentile": 66.1, "90th_percentile": 66.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 31.05, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 31.05, "10th_percentile": 31.05, "90th_percentile": 31.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 15.83, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 15.83, "10th_percentile": 15.83, "90th_percentile": 15.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 64.96, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 64.96, "10th_percentile": 64.96, "90th_percentile": 64.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 58.3, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.3, "10th_percentile": 58.3, "90th_percentile": 58.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 29.41, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 29.41, "10th_percentile": 29.41, "90th_percentile": 29.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 86.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 86.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 86.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 45.93, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.93, "10th_percentile": 45.93, "90th_percentile": 45.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 43.42, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.42, "10th_percentile": 43.42, "90th_percentile": 43.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 56.23, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 56.23, "10th_percentile": 56.23, "90th_percentile": 56.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 38.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 38.93, "10th_percentile": 38.93, "90th_percentile": 38.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 64.88, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 64.88, "10th_percentile": 64.88, "90th_percentile": 64.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 67.47, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 67.47, "10th_percentile": 67.47, "90th_percentile": 67.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 65.39, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 65.39, "10th_percentile": 65.39, "90th_percentile": 65.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 57.43, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 57.43, "10th_percentile": 57.43, "90th_percentile": 57.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 45.59, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.59, "10th_percentile": 45.59, "90th_percentile": 45.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 57.87, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.87, "10th_percentile": 57.87, "90th_percentile": 57.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 79.58, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 79.58, "10th_percentile": 79.58, "90th_percentile": 79.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 66.1, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 66.1, "10th_percentile": 66.1, "90th_percentile": 66.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "BUR SURG MIS 2.2X12.0MM SHANNON LARGA TAILORS BUNION", "code_information": [ { "code": "SUP-453646", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1.53, "maximum": 8.36, "setting": "outpatient", "gross_charge": 8.36, "discounted_cash": 5.85, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.19, "10th_percentile": 7.19, "90th_percentile": 7.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.19, "10th_percentile": 7.19, "90th_percentile": 7.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.19, "10th_percentile": 7.19, "90th_percentile": 7.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7.19, "10th_percentile": 7.19, "90th_percentile": 7.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5.14, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.14, "10th_percentile": 5.14, "90th_percentile": 5.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 6.39, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.39, "10th_percentile": 6.39, "90th_percentile": 6.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4.67, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.67, "10th_percentile": 4.67, "90th_percentile": 4.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5.55, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5.55, "10th_percentile": 5.55, "90th_percentile": 5.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 4.9, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.9, "10th_percentile": 4.9, "90th_percentile": 4.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 4.9, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.9, "10th_percentile": 4.9, "90th_percentile": 4.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.53, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1.53, "10th_percentile": 1.53, "90th_percentile": 1.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 3.0, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 5.63, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.63, "10th_percentile": 5.63, "90th_percentile": 5.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 2.84, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 2.84, "10th_percentile": 2.84, "90th_percentile": 2.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 6.28, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.28, "10th_percentile": 6.28, "90th_percentile": 6.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 8.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 8.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 5.59, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.59, "10th_percentile": 5.59, "90th_percentile": 5.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 7.69, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 7.69, "10th_percentile": 7.69, "90th_percentile": 7.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 4.41, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.41, "10th_percentile": 4.41, "90th_percentile": 4.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 4.44, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.44, "10th_percentile": 4.44, "90th_percentile": 4.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 6.52, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 6.52, "10th_percentile": 6.52, "90th_percentile": 6.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 3.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 3.76, "10th_percentile": 3.76, "90th_percentile": 3.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5.55, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5.55, "10th_percentile": 5.55, "90th_percentile": 5.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 6.27, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 6.27, "10th_percentile": 6.27, "90th_percentile": 6.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 6.39, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.39, "10th_percentile": 6.39, "90th_percentile": 6.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 5.43, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 5.43, "10th_percentile": 5.43, "90th_percentile": 5.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 4.2, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 6.32, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 6.32, "10th_percentile": 6.32, "90th_percentile": 6.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.36, "10th_percentile": 8.36, "90th_percentile": 8.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BURR 4MM ROUND AR-8400RBE", "code_information": [ { "code": "SUP-317725", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 144.97, "maximum": 792.16, "setting": "outpatient", "gross_charge": 792.16, "discounted_cash": 554.51, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 681.26, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 681.26, "10th_percentile": 681.26, "90th_percentile": 681.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 681.26, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 681.26, "10th_percentile": 681.26, "90th_percentile": 681.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 681.26, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 681.26, "10th_percentile": 681.26, "90th_percentile": 681.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 681.26, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 681.26, "10th_percentile": 681.26, "90th_percentile": 681.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 487.26, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 487.26, "10th_percentile": 487.26, "90th_percentile": 487.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 605.37, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 605.37, "10th_percentile": 605.37, "90th_percentile": 605.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 442.82, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 442.82, "10th_percentile": 442.82, "90th_percentile": 442.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 792.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 525.92, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 525.92, "10th_percentile": 525.92, "90th_percentile": 525.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 464.05, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 464.05, "10th_percentile": 464.05, "90th_percentile": 464.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 464.05, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 464.05, "10th_percentile": 464.05, "90th_percentile": 464.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 144.97, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 144.97, "10th_percentile": 144.97, "90th_percentile": 144.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 284.39, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 284.39, "10th_percentile": 284.39, "90th_percentile": 284.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 533.92, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 533.92, "10th_percentile": 533.92, "90th_percentile": 533.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 269.33, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 269.33, "10th_percentile": 269.33, "90th_percentile": 269.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 594.91, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 594.91, "10th_percentile": 594.91, "90th_percentile": 594.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 792.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 792.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 792.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 529.96, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 529.96, "10th_percentile": 529.96, "90th_percentile": 529.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 728.79, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 728.79, "10th_percentile": 728.79, "90th_percentile": 728.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 417.47, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 417.47, "10th_percentile": 417.47, "90th_percentile": 417.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 420.64, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 420.64, "10th_percentile": 420.64, "90th_percentile": 420.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 617.88, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 617.88, "10th_percentile": 617.88, "90th_percentile": 617.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 356.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 356.47, "10th_percentile": 356.47, "90th_percentile": 356.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 525.92, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 525.92, "10th_percentile": 525.92, "90th_percentile": 525.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 594.12, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 594.12, "10th_percentile": 594.12, "90th_percentile": 594.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 605.37, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 605.37, "10th_percentile": 605.37, "90th_percentile": 605.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 514.9, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 514.9, "10th_percentile": 514.9, "90th_percentile": 514.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 397.66, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 397.66, "10th_percentile": 397.66, "90th_percentile": 397.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 598.87, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 598.87, "10th_percentile": 598.87, "90th_percentile": 598.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BURR ROUND 8 FLUTE 5.5MMX13CM", "code_information": [ { "code": "SUP-317276", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 144.97, "maximum": 792.16, "setting": "outpatient", "gross_charge": 792.16, "discounted_cash": 554.51, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 681.26, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 681.26, "10th_percentile": 681.26, "90th_percentile": 681.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 681.26, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 681.26, "10th_percentile": 681.26, "90th_percentile": 681.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 681.26, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 681.26, "10th_percentile": 681.26, "90th_percentile": 681.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 681.26, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 681.26, "10th_percentile": 681.26, "90th_percentile": 681.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 487.26, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 487.26, "10th_percentile": 487.26, "90th_percentile": 487.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 605.37, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 605.37, "10th_percentile": 605.37, "90th_percentile": 605.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 442.82, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 442.82, "10th_percentile": 442.82, "90th_percentile": 442.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 792.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 525.92, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 525.92, "10th_percentile": 525.92, "90th_percentile": 525.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 464.05, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 464.05, "10th_percentile": 464.05, "90th_percentile": 464.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 464.05, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 464.05, "10th_percentile": 464.05, "90th_percentile": 464.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 144.97, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 144.97, "10th_percentile": 144.97, "90th_percentile": 144.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 284.39, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 284.39, "10th_percentile": 284.39, "90th_percentile": 284.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 533.92, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 533.92, "10th_percentile": 533.92, "90th_percentile": 533.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 269.33, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 269.33, "10th_percentile": 269.33, "90th_percentile": 269.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 594.91, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 594.91, "10th_percentile": 594.91, "90th_percentile": 594.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 792.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 792.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 792.16, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 529.96, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 529.96, "10th_percentile": 529.96, "90th_percentile": 529.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 728.79, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 728.79, "10th_percentile": 728.79, "90th_percentile": 728.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 417.47, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 417.47, "10th_percentile": 417.47, "90th_percentile": 417.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 420.64, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 420.64, "10th_percentile": 420.64, "90th_percentile": 420.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 617.88, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 617.88, "10th_percentile": 617.88, "90th_percentile": 617.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 356.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 356.47, "10th_percentile": 356.47, "90th_percentile": 356.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 525.92, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 525.92, "10th_percentile": 525.92, "90th_percentile": 525.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 594.12, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 594.12, "10th_percentile": 594.12, "90th_percentile": 594.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 605.37, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 605.37, "10th_percentile": 605.37, "90th_percentile": 605.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 514.9, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 514.9, "10th_percentile": 514.9, "90th_percentile": 514.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 397.66, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 397.66, "10th_percentile": 397.66, "90th_percentile": 397.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 598.87, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 598.87, "10th_percentile": 598.87, "90th_percentile": 598.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 792.16, "10th_percentile": 792.16, "90th_percentile": 792.16, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CABAZITAXEL 10 MG/ML (FIRST DILUTION) IV SOLN", "drug_information": { "unit": 6.0, "type": "ML" }, "code_information": [ { "code": "RX-183803", "type": "CDM" }, { "code": "J9043", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00024-5824-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 82893.83, "maximum": 452971.75, "setting": "outpatient", "gross_charge": 452971.75, "discounted_cash": 317080.22, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 452971.75, "10th_percentile": 452971.75, "90th_percentile": 452971.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 11.5% = $52,091.75 due to $0.00 Claim Price", "median_amount": 52091.75, "10th_percentile": 52091.75, "90th_percentile": 52091.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 11.5% = $52,091.75 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 11.5% = $52,091.75 due to $0.00 Claim Price", "median_amount": 52091.75, "10th_percentile": 52091.75, "90th_percentile": 52091.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 11.5% = $52,091.75 due to $0.00 Claim Price" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31255.05, "10th_percentile": 31255.05, "90th_percentile": 31255.05, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31255.05, "10th_percentile": 31255.05, "90th_percentile": 31255.05, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31255.05, "10th_percentile": 31255.05, "90th_percentile": 31255.05, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31255.05, "10th_percentile": 31255.05, "90th_percentile": 31255.05, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31255.05, "10th_percentile": 31255.05, "90th_percentile": 31255.05, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31255.05, "10th_percentile": 31255.05, "90th_percentile": 31255.05, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 31255.05, "10th_percentile": 31255.05, "90th_percentile": 31255.05, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $452,971.75 @ 6.9% = $31,255.05 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 389555.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 389555.72, "10th_percentile": 389555.72, "90th_percentile": 389555.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 389555.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 389555.72, "10th_percentile": 389555.72, "90th_percentile": 389555.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 389555.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 389555.72, "10th_percentile": 389555.72, "90th_percentile": 389555.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 389555.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 389555.72, "10th_percentile": 389555.72, "90th_percentile": 389555.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 273594.94, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273594.94, "10th_percentile": 273594.94, "90th_percentile": 273594.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 273594.94, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273594.94, "10th_percentile": 273594.94, "90th_percentile": 273594.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 273594.94, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 273594.94, "10th_percentile": 273594.94, "90th_percentile": 273594.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 452971.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 452971.75, "10th_percentile": 452971.75, "90th_percentile": 452971.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 452971.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 452971.75, "10th_percentile": 452971.75, "90th_percentile": 452971.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 300727.94, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 300727.94, "10th_percentile": 300727.94, "90th_percentile": 300727.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 300727.94, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 300727.94, "10th_percentile": 300727.94, "90th_percentile": 300727.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 321609.94, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 321609.94, "10th_percentile": 321609.94, "90th_percentile": 321609.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 321609.94, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 321609.94, "10th_percentile": 321609.94, "90th_percentile": 321609.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 82893.83, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 82893.83, "10th_percentile": 82893.83, "90th_percentile": 82893.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 154010.4, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 154010.4, "10th_percentile": 154010.4, "90th_percentile": 154010.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 162616.86, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 162616.86, "10th_percentile": 162616.86, "90th_percentile": 162616.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 452971.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 452971.75, "10th_percentile": 452971.75, "90th_percentile": 452971.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 342446.62, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 342446.62, "10th_percentile": 342446.62, "90th_percentile": 342446.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 339728.8, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 339728.8, "10th_percentile": 339728.8, "90th_percentile": 339728.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 452971.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 452971.75, "10th_percentile": 452971.75, "90th_percentile": 452971.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 416734.0, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 416734.0, "10th_percentile": 416734.0, "90th_percentile": 416734.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 203837.3, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 203837.3, "10th_percentile": 203837.3, "90th_percentile": 203837.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 353317.97, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 353317.97, "10th_percentile": 353317.97, "90th_percentile": 353317.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 253211.2, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 253211.2, "10th_percentile": 253211.2, "90th_percentile": 253211.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "CALCITRIOL 0.25 MCG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9350", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "64380-0723-04", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.01, "maximum": 5.5, "setting": "outpatient", "gross_charge": 5.5, "discounted_cash": 3.85, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.22, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.22, "10th_percentile": 3.22, "90th_percentile": 3.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.22, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.22, "10th_percentile": 3.22, "90th_percentile": 3.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 3.65, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 3.65, "10th_percentile": 3.65, "90th_percentile": 3.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.38, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.38, "10th_percentile": 3.38, "90th_percentile": 3.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3.07, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.07, "10th_percentile": 3.07, "90th_percentile": 3.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4.2, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1.97, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1.97, "10th_percentile": 1.97, "90th_percentile": 1.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.01, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 4.13, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.13, "10th_percentile": 4.13, "90th_percentile": 4.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 3.71, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.71, "10th_percentile": 3.71, "90th_percentile": 3.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1.87, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1.87, "10th_percentile": 1.87, "90th_percentile": 1.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 2.92, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.92, "10th_percentile": 2.92, "90th_percentile": 2.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 2.76, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.76, "10th_percentile": 2.76, "90th_percentile": 2.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 3.58, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 3.58, "10th_percentile": 3.58, "90th_percentile": 3.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 2.48, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 4.13, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 4.13, "10th_percentile": 4.13, "90th_percentile": 4.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 4.29, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 4.29, "10th_percentile": 4.29, "90th_percentile": 4.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 4.16, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 4.16, "10th_percentile": 4.16, "90th_percentile": 4.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 3.65, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 3.65, "10th_percentile": 3.65, "90th_percentile": 3.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 2.9, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.9, "10th_percentile": 2.9, "90th_percentile": 2.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 3.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.68, "10th_percentile": 3.68, "90th_percentile": 3.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 5.06, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 5.06, "10th_percentile": 5.06, "90th_percentile": 5.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4.2, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.2, "10th_percentile": 4.2, "90th_percentile": 4.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "CALCIUM CARBONATE 200 MG CALCIUM (500 MG) ORAL CHEW", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9385", "type": "CDM" }, { "code": "J8499", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "00536-1007-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.41, "maximum": 2.25, "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.16, "10th_percentile": 0.16, "90th_percentile": 0.16, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.9% = $0.16 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price", "median_amount": 0.26, "10th_percentile": 0.26, "90th_percentile": 0.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price", "median_amount": 0.26, "10th_percentile": 0.26, "90th_percentile": 0.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 11.5% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_algorithm": "1500 Profees; Pricing Extension - HB XR PRC - UHC MULTI 1084056547 & 41371; Note: Multiple pricing methods applied. Calculated as percentage of fee schedule KH HB XR UHC PROF 1500 FSC. Fee schedule rate: 0.00 per unit. 1 unit from Tier 1 @ 100%. Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "1500 Profees; Pricing Extension - HB XR PRC - UHC MULTI 1084056547 & 41371; Note: Multiple pricing methods applied. Calculated as percentage of fee schedule KH HB XR UHC PROF 1500 FSC. Fee schedule rate: 0.00 per unit. 1 unit from Tier 1 @ 100%. Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_algorithm": "1500 Profees; Pricing Extension - HB XR PRC - UHC MULTI 1084056547 & 41371; Note: Multiple pricing methods applied. Calculated as percentage of fee schedule KH HB XR UHC PROF 1500 FSC. Fee schedule rate: 0.00 per unit. 1 unit from Tier 1 @ 100%. Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "1500 Profees; Pricing Extension - HB XR PRC - UHC MULTI 1084056547 & 41371; Note: Multiple pricing methods applied. Calculated as percentage of fee schedule KH HB XR UHC PROF 1500 FSC. Fee schedule rate: 0.00 per unit. 1 unit from Tier 1 @ 100%. Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_algorithm": "No contract line matched", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.36, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.36, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.36, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.49, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.49, "10th_percentile": 1.49, "90th_percentile": 1.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.6, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.6, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2.07, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2.07, "10th_percentile": 2.07, "90th_percentile": 2.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1.01, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1.01, "10th_percentile": 1.01, "90th_percentile": 1.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.41, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.41, "10th_percentile": 0.41, "90th_percentile": 0.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.26, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.26, "10th_percentile": 1.26, "90th_percentile": 1.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1.7, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1.7, "10th_percentile": 1.7, "90th_percentile": 1.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1.76, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1.76, "10th_percentile": 1.76, "90th_percentile": 1.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." } ] } ] }, { "description": "CANNULA OPTH 11MM 27GA ANG AC NDL 8065441720", "code_information": [ { "code": "SUP-413560", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 32.64, "maximum": 178.35, "setting": "outpatient", "gross_charge": 178.35, "discounted_cash": 124.84, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 153.38, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 153.38, "10th_percentile": 153.38, "90th_percentile": 153.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 153.38, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 153.38, "10th_percentile": 153.38, "90th_percentile": 153.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 153.38, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 153.38, "10th_percentile": 153.38, "90th_percentile": 153.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 153.38, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 153.38, "10th_percentile": 153.38, "90th_percentile": 153.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 109.7, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 109.7, "10th_percentile": 109.7, "90th_percentile": 109.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 136.3, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 136.3, "10th_percentile": 136.3, "90th_percentile": 136.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 99.7, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 99.7, "10th_percentile": 99.7, "90th_percentile": 99.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 178.35, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 118.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 118.41, "10th_percentile": 118.41, "90th_percentile": 118.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 104.48, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.48, "10th_percentile": 104.48, "90th_percentile": 104.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 104.48, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.48, "10th_percentile": 104.48, "90th_percentile": 104.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 32.64, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 64.03, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 64.03, "10th_percentile": 64.03, "90th_percentile": 64.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 120.21, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 120.21, "10th_percentile": 120.21, "90th_percentile": 120.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 60.64, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 60.64, "10th_percentile": 60.64, "90th_percentile": 60.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 133.94, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 133.94, "10th_percentile": 133.94, "90th_percentile": 133.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 178.35, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 178.35, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 178.35, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 119.32, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 119.32, "10th_percentile": 119.32, "90th_percentile": 119.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 164.08, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 164.08, "10th_percentile": 164.08, "90th_percentile": 164.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 93.99, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 93.99, "10th_percentile": 93.99, "90th_percentile": 93.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 94.7, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.7, "10th_percentile": 94.7, "90th_percentile": 94.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 139.11, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 139.11, "10th_percentile": 139.11, "90th_percentile": 139.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 80.26, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 80.26, "10th_percentile": 80.26, "90th_percentile": 80.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 118.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 118.41, "10th_percentile": 118.41, "90th_percentile": 118.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 133.76, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 133.76, "10th_percentile": 133.76, "90th_percentile": 133.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 136.3, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 136.3, "10th_percentile": 136.3, "90th_percentile": 136.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 115.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 115.93, "10th_percentile": 115.93, "90th_percentile": 115.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 89.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 89.53, "10th_percentile": 89.53, "90th_percentile": 89.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 134.83, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 134.83, "10th_percentile": 134.83, "90th_percentile": 134.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CANNULA THREADED 8.25X7CM AR-6530", "code_information": [ { "code": "SUP-9054341", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 67.57, "maximum": 369.23, "setting": "outpatient", "gross_charge": 369.23, "discounted_cash": 258.46, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 317.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 317.54, "10th_percentile": 317.54, "90th_percentile": 317.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 317.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 317.54, "10th_percentile": 317.54, "90th_percentile": 317.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 317.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 317.54, "10th_percentile": 317.54, "90th_percentile": 317.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 317.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 317.54, "10th_percentile": 317.54, "90th_percentile": 317.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 227.11, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 227.11, "10th_percentile": 227.11, "90th_percentile": 227.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 282.17, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 282.17, "10th_percentile": 282.17, "90th_percentile": 282.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 206.4, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 206.4, "10th_percentile": 206.4, "90th_percentile": 206.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 369.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 245.13, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 245.13, "10th_percentile": 245.13, "90th_percentile": 245.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 216.29, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 216.29, "10th_percentile": 216.29, "90th_percentile": 216.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 216.29, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 216.29, "10th_percentile": 216.29, "90th_percentile": 216.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 67.57, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 67.57, "10th_percentile": 67.57, "90th_percentile": 67.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 132.55, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 132.55, "10th_percentile": 132.55, "90th_percentile": 132.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 248.86, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 248.86, "10th_percentile": 248.86, "90th_percentile": 248.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 125.54, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 125.54, "10th_percentile": 125.54, "90th_percentile": 125.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 277.29, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 277.29, "10th_percentile": 277.29, "90th_percentile": 277.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 369.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 369.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 369.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 247.01, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.01, "10th_percentile": 247.01, "90th_percentile": 247.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 339.69, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 339.69, "10th_percentile": 339.69, "90th_percentile": 339.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 194.58, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 194.58, "10th_percentile": 194.58, "90th_percentile": 194.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 196.06, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 196.06, "10th_percentile": 196.06, "90th_percentile": 196.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 288.0, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 288.0, "10th_percentile": 288.0, "90th_percentile": 288.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 166.15, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 166.15, "10th_percentile": 166.15, "90th_percentile": 166.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 245.13, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 245.13, "10th_percentile": 245.13, "90th_percentile": 245.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 276.92, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 276.92, "10th_percentile": 276.92, "90th_percentile": 276.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 282.17, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 282.17, "10th_percentile": 282.17, "90th_percentile": 282.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 240.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 240.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 185.35, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 185.35, "10th_percentile": 185.35, "90th_percentile": 185.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 279.14, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 279.14, "10th_percentile": 279.14, "90th_percentile": 279.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CAP CNNL 8MM STNDRD LNGTH OBTRTR WTH BLDLSS ARSL", "code_information": [ { "code": "SUP-432183", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 174.45, "maximum": 953.29, "setting": "outpatient", "gross_charge": 953.29, "discounted_cash": 667.3, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 819.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 819.83, "10th_percentile": 819.83, "90th_percentile": 819.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 819.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 819.83, "10th_percentile": 819.83, "90th_percentile": 819.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 819.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 819.83, "10th_percentile": 819.83, "90th_percentile": 819.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 819.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 819.83, "10th_percentile": 819.83, "90th_percentile": 819.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 586.37, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 586.37, "10th_percentile": 586.37, "90th_percentile": 586.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 728.5, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 728.5, "10th_percentile": 728.5, "90th_percentile": 728.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 532.89, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 532.89, "10th_percentile": 532.89, "90th_percentile": 532.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 953.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 632.89, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 632.89, "10th_percentile": 632.89, "90th_percentile": 632.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 558.44, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 558.44, "10th_percentile": 558.44, "90th_percentile": 558.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 558.44, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 558.44, "10th_percentile": 558.44, "90th_percentile": 558.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 174.45, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 174.45, "10th_percentile": 174.45, "90th_percentile": 174.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 342.23, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 342.23, "10th_percentile": 342.23, "90th_percentile": 342.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 642.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 642.52, "10th_percentile": 642.52, "90th_percentile": 642.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 324.12, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 324.12, "10th_percentile": 324.12, "90th_percentile": 324.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 715.92, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 715.92, "10th_percentile": 715.92, "90th_percentile": 715.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 953.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 953.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 953.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 637.75, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 637.75, "10th_percentile": 637.75, "90th_percentile": 637.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 877.03, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 877.03, "10th_percentile": 877.03, "90th_percentile": 877.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 502.38, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 502.38, "10th_percentile": 502.38, "90th_percentile": 502.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 506.2, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 506.2, "10th_percentile": 506.2, "90th_percentile": 506.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 743.57, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 743.57, "10th_percentile": 743.57, "90th_percentile": 743.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 428.98, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 428.98, "10th_percentile": 428.98, "90th_percentile": 428.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 632.89, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 632.89, "10th_percentile": 632.89, "90th_percentile": 632.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 714.97, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 714.97, "10th_percentile": 714.97, "90th_percentile": 714.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 728.5, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 728.5, "10th_percentile": 728.5, "90th_percentile": 728.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 619.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 619.64, "10th_percentile": 619.64, "90th_percentile": 619.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 478.55, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 478.55, "10th_percentile": 478.55, "90th_percentile": 478.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 720.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 720.69, "10th_percentile": 720.69, "90th_percentile": 720.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 953.29, "10th_percentile": 953.29, "90th_percentile": 953.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CAPSURE SENSE MRI SURESCAN 4074- 52CM PACEMAKER LEAD", "code_information": [ { "code": "SUP-160173", "type": "CDM" }, { "code": "C1898", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 690.41, "maximum": 3772.72, "setting": "outpatient", "gross_charge": 3772.72, "discounted_cash": 2640.9, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1988.22, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1988.22, "10th_percentile": 1988.22, "90th_percentile": 1988.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 2003.31, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2003.31, "10th_percentile": 2003.31, "90th_percentile": 2003.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 2523.95, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2523.95, "10th_percentile": 2523.95, "90th_percentile": 2523.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 2452.27, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 2452.27, "10th_percentile": 2452.27, "90th_percentile": 2452.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1893.91, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1893.91, "10th_percentile": 1893.91, "90th_percentile": 1893.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2108.95, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2108.95, "10th_percentile": 2108.95, "90th_percentile": 2108.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 2942.72, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 2942.72, "10th_percentile": 2942.72, "90th_percentile": 2942.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2852.18, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2852.18, "10th_percentile": 2852.18, "90th_percentile": 2852.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2829.54, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2829.54, "10th_percentile": 2829.54, "90th_percentile": 2829.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 3772.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 3772.72, "10th_percentile": 3772.72, "90th_percentile": 3772.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3772.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3772.72, "10th_percentile": 3772.72, "90th_percentile": 3772.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1697.72, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1697.72, "10th_percentile": 1697.72, "90th_percentile": 1697.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 3470.9, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 3470.9, "10th_percentile": 3470.9, "90th_percentile": 3470.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 2542.81, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2542.81, "10th_percentile": 2542.81, "90th_percentile": 2542.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1354.41, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1354.41, "10th_percentile": 1354.41, "90th_percentile": 1354.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 690.41, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 690.41, "10th_percentile": 690.41, "90th_percentile": 690.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 2833.31, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2833.31, "10th_percentile": 2833.31, "90th_percentile": 2833.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1282.72, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1282.72, "10th_percentile": 1282.72, "90th_percentile": 1282.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2678.63, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2678.63, "10th_percentile": 2678.63, "90th_percentile": 2678.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2678.63, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2678.63, "10th_percentile": 2678.63, "90th_percentile": 2678.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3772.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3772.72, "10th_percentile": 3772.72, "90th_percentile": 3772.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3772.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3772.72, "10th_percentile": 3772.72, "90th_percentile": 3772.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2504.71, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2504.71, "10th_percentile": 2504.71, "90th_percentile": 2504.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2504.71, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2504.71, "10th_percentile": 2504.71, "90th_percentile": 2504.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2278.72, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2278.72, "10th_percentile": 2278.72, "90th_percentile": 2278.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2278.72, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2278.72, "10th_percentile": 2278.72, "90th_percentile": 2278.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2278.72, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2278.72, "10th_percentile": 2278.72, "90th_percentile": 2278.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3244.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3244.54, "10th_percentile": 3244.54, "90th_percentile": 3244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3244.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3244.54, "10th_percentile": 3244.54, "90th_percentile": 3244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3244.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3244.54, "10th_percentile": 3244.54, "90th_percentile": 3244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 3244.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 3244.54, "10th_percentile": 3244.54, "90th_percentile": 3244.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.32, "10th_percentile": 260.32, "90th_percentile": 260.32, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.32, "10th_percentile": 260.32, "90th_percentile": 260.32, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.32, "10th_percentile": 260.32, "90th_percentile": 260.32, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.32, "10th_percentile": 260.32, "90th_percentile": 260.32, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.32, "10th_percentile": 260.32, "90th_percentile": 260.32, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.32, "10th_percentile": 260.32, "90th_percentile": 260.32, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 260.32, "10th_percentile": 260.32, "90th_percentile": 260.32, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 6.9% = $260.32 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 11.5% = $433.86 due to $0.00 Claim Price", "median_amount": 433.86, "10th_percentile": 433.86, "90th_percentile": 433.86, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 11.5% = $433.86 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 11.5% = $433.86 due to $0.00 Claim Price", "median_amount": 433.86, "10th_percentile": 433.86, "90th_percentile": 433.86, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,772.72 @ 11.5% = $433.86 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3772.72, "10th_percentile": 3772.72, "90th_percentile": 3772.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CARBIDOPA-LEVODOPA 50-200 MG ORAL TBER", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-9409", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51079-0923-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.02, "maximum": 16.5, "setting": "outpatient", "gross_charge": 16.5, "discounted_cash": 11.55, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 14.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 14.19, "10th_percentile": 14.19, "90th_percentile": 14.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 14.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 14.19, "10th_percentile": 14.19, "90th_percentile": 14.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 14.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 14.19, "10th_percentile": 14.19, "90th_percentile": 14.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 14.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 14.19, "10th_percentile": 14.19, "90th_percentile": 14.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 9.67, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.67, "10th_percentile": 9.67, "90th_percentile": 9.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 9.67, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.67, "10th_percentile": 9.67, "90th_percentile": 9.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 10.95, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 10.95, "10th_percentile": 10.95, "90th_percentile": 10.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 16.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 10.15, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10.15, "10th_percentile": 10.15, "90th_percentile": 10.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 9.22, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9.22, "10th_percentile": 9.22, "90th_percentile": 9.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 12.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.61, "10th_percentile": 12.61, "90th_percentile": 12.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 5.92, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 5.92, "10th_percentile": 5.92, "90th_percentile": 5.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.02, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 3.02, "10th_percentile": 3.02, "90th_percentile": 3.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 12.39, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.39, "10th_percentile": 12.39, "90th_percentile": 12.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 11.12, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.12, "10th_percentile": 11.12, "90th_percentile": 11.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 5.61, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 5.61, "10th_percentile": 5.61, "90th_percentile": 5.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 16.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 16.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 16.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16.5, "10th_percentile": 16.5, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 8.76, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.76, "10th_percentile": 8.76, "90th_percentile": 8.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 8.28, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.28, "10th_percentile": 8.28, "90th_percentile": 8.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 10.73, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 10.73, "10th_percentile": 10.73, "90th_percentile": 10.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 7.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 7.43, "10th_percentile": 7.43, "90th_percentile": 7.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 12.38, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 12.38, "10th_percentile": 12.38, "90th_percentile": 12.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 12.87, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 12.87, "10th_percentile": 12.87, "90th_percentile": 12.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 12.47, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 12.47, "10th_percentile": 12.47, "90th_percentile": 12.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 10.95, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 10.95, "10th_percentile": 10.95, "90th_percentile": 10.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 8.7, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8.7, "10th_percentile": 8.7, "90th_percentile": 8.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 11.04, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11.04, "10th_percentile": 11.04, "90th_percentile": 11.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 15.18, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 15.18, "10th_percentile": 15.18, "90th_percentile": 15.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 12.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12.61, "10th_percentile": 12.61, "90th_percentile": 12.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "CARBOPLATIN 10 MG/ML IV SOLN", "drug_information": { "unit": 45.0, "type": "ML" }, "code_information": [ { "code": "RX-39267", "type": "CDM" }, { "code": "J9045", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00703-4248-81", "type": "NDC" } ], "standard_charges": [ { "minimum": 580.48, "maximum": 3172.0, "setting": "outpatient", "gross_charge": 3172.0, "discounted_cash": 2220.4, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3172.0, "10th_percentile": 3172.0, "90th_percentile": 3172.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 11.5% = $364.78 due to $0.00 Claim Price", "median_amount": 364.78, "10th_percentile": 364.78, "90th_percentile": 364.78, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 11.5% = $364.78 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 11.5% = $364.78 due to $0.00 Claim Price", "median_amount": 364.78, "10th_percentile": 364.78, "90th_percentile": 364.78, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 11.5% = $364.78 due to $0.00 Claim Price" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.87, "10th_percentile": 218.87, "90th_percentile": 218.87, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.87, "10th_percentile": 218.87, "90th_percentile": 218.87, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.87, "10th_percentile": 218.87, "90th_percentile": 218.87, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.87, "10th_percentile": 218.87, "90th_percentile": 218.87, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.87, "10th_percentile": 218.87, "90th_percentile": 218.87, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.87, "10th_percentile": 218.87, "90th_percentile": 218.87, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.87, "10th_percentile": 218.87, "90th_percentile": 218.87, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,172.00 @ 6.9% = $218.87 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2727.92, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2727.92, "10th_percentile": 2727.92, "90th_percentile": 2727.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2727.92, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2727.92, "10th_percentile": 2727.92, "90th_percentile": 2727.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2727.92, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2727.92, "10th_percentile": 2727.92, "90th_percentile": 2727.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2727.92, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2727.92, "10th_percentile": 2727.92, "90th_percentile": 2727.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1915.89, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1915.89, "10th_percentile": 1915.89, "90th_percentile": 1915.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1915.89, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1915.89, "10th_percentile": 1915.89, "90th_percentile": 1915.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1915.89, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1915.89, "10th_percentile": 1915.89, "90th_percentile": 1915.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3172.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3172.0, "10th_percentile": 3172.0, "90th_percentile": 3172.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3172.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3172.0, "10th_percentile": 3172.0, "90th_percentile": 3172.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2105.89, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2105.89, "10th_percentile": 2105.89, "90th_percentile": 2105.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 2105.89, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 2105.89, "10th_percentile": 2105.89, "90th_percentile": 2105.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2252.12, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2252.12, "10th_percentile": 2252.12, "90th_percentile": 2252.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2252.12, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2252.12, "10th_percentile": 2252.12, "90th_percentile": 2252.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 580.48, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 580.48, "10th_percentile": 580.48, "90th_percentile": 580.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1078.48, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1078.48, "10th_percentile": 1078.48, "90th_percentile": 1078.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1138.75, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1138.75, "10th_percentile": 1138.75, "90th_percentile": 1138.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 3172.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 3172.0, "10th_percentile": 3172.0, "90th_percentile": 3172.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2398.03, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2398.03, "10th_percentile": 2398.03, "90th_percentile": 2398.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2379.0, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2379.0, "10th_percentile": 2379.0, "90th_percentile": 2379.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3172.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3172.0, "10th_percentile": 3172.0, "90th_percentile": 3172.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2918.24, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2918.24, "10th_percentile": 2918.24, "90th_percentile": 2918.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1427.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1427.4, "10th_percentile": 1427.4, "90th_percentile": 1427.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 2474.16, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 2474.16, "10th_percentile": 2474.16, "90th_percentile": 2474.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1773.15, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1773.15, "10th_percentile": 1773.15, "90th_percentile": 1773.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "CARBOPLATIN 10 MG/ML IV SOLN", "drug_information": { "unit": 60.0, "type": "ML" }, "code_information": [ { "code": "RX-39267", "type": "CDM" }, { "code": "J9045", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "61703-0339-56", "type": "NDC" } ], "standard_charges": [ { "minimum": 527.27, "maximum": 2881.25, "setting": "outpatient", "gross_charge": 2881.25, "discounted_cash": 2016.87, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2881.25, "10th_percentile": 2881.25, "90th_percentile": 2881.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 11.5% = $331.34 due to $0.00 Claim Price", "median_amount": 331.34, "10th_percentile": 331.34, "90th_percentile": 331.34, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 11.5% = $331.34 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 11.5% = $331.34 due to $0.00 Claim Price", "median_amount": 331.34, "10th_percentile": 331.34, "90th_percentile": 331.34, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 11.5% = $331.34 due to $0.00 Claim Price" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 198.81, "10th_percentile": 198.81, "90th_percentile": 198.81, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 198.81, "10th_percentile": 198.81, "90th_percentile": 198.81, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 198.81, "10th_percentile": 198.81, "90th_percentile": 198.81, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 198.81, "10th_percentile": 198.81, "90th_percentile": 198.81, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 198.81, "10th_percentile": 198.81, "90th_percentile": 198.81, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 198.81, "10th_percentile": 198.81, "90th_percentile": 198.81, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 198.81, "10th_percentile": 198.81, "90th_percentile": 198.81, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,881.25 @ 6.9% = $198.81 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2477.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2477.88, "10th_percentile": 2477.88, "90th_percentile": 2477.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2477.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2477.88, "10th_percentile": 2477.88, "90th_percentile": 2477.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2477.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2477.88, "10th_percentile": 2477.88, "90th_percentile": 2477.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2477.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2477.88, "10th_percentile": 2477.88, "90th_percentile": 2477.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1740.28, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1740.28, "10th_percentile": 1740.28, "90th_percentile": 1740.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1740.28, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1740.28, "10th_percentile": 1740.28, "90th_percentile": 1740.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1740.28, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1740.28, "10th_percentile": 1740.28, "90th_percentile": 1740.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2881.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2881.25, "10th_percentile": 2881.25, "90th_percentile": 2881.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2881.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2881.25, "10th_percentile": 2881.25, "90th_percentile": 2881.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1912.86, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1912.86, "10th_percentile": 1912.86, "90th_percentile": 1912.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1912.86, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1912.86, "10th_percentile": 1912.86, "90th_percentile": 1912.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2045.69, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2045.69, "10th_percentile": 2045.69, "90th_percentile": 2045.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 2045.69, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2045.69, "10th_percentile": 2045.69, "90th_percentile": 2045.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 527.27, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 527.27, "10th_percentile": 527.27, "90th_percentile": 527.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 979.63, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 979.63, "10th_percentile": 979.63, "90th_percentile": 979.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1034.37, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1034.37, "10th_percentile": 1034.37, "90th_percentile": 1034.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2881.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2881.25, "10th_percentile": 2881.25, "90th_percentile": 2881.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2178.23, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2178.23, "10th_percentile": 2178.23, "90th_percentile": 2178.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2160.94, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2160.94, "10th_percentile": 2160.94, "90th_percentile": 2160.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2881.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2881.25, "10th_percentile": 2881.25, "90th_percentile": 2881.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2650.75, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2650.75, "10th_percentile": 2650.75, "90th_percentile": 2650.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1296.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1296.56, "10th_percentile": 1296.56, "90th_percentile": 1296.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 2247.38, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 2247.38, "10th_percentile": 2247.38, "90th_percentile": 2247.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1610.62, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1610.62, "10th_percentile": 1610.62, "90th_percentile": 1610.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "CARBOPLATIN 10 MG/ML IV SOLN", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-39267", "type": "CDM" }, { "code": "J9045", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "69448-0005-38", "type": "NDC" } ], "standard_charges": [ { "minimum": 510.52, "maximum": 2789.75, "setting": "outpatient", "gross_charge": 2789.75, "discounted_cash": 1952.82, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2789.75, "10th_percentile": 2789.75, "90th_percentile": 2789.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 11.5% = $320.82 due to $0.00 Claim Price", "median_amount": 320.82, "10th_percentile": 320.82, "90th_percentile": 320.82, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 11.5% = $320.82 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 11.5% = $320.82 due to $0.00 Claim Price", "median_amount": 320.82, "10th_percentile": 320.82, "90th_percentile": 320.82, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 11.5% = $320.82 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.49, "10th_percentile": 192.49, "90th_percentile": 192.49, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.49, "10th_percentile": 192.49, "90th_percentile": 192.49, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.49, "10th_percentile": 192.49, "90th_percentile": 192.49, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.49, "10th_percentile": 192.49, "90th_percentile": 192.49, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.49, "10th_percentile": 192.49, "90th_percentile": 192.49, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.49, "10th_percentile": 192.49, "90th_percentile": 192.49, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.49, "10th_percentile": 192.49, "90th_percentile": 192.49, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,789.75 @ 6.9% = $192.49 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2399.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2399.19, "10th_percentile": 2399.19, "90th_percentile": 2399.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2399.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2399.19, "10th_percentile": 2399.19, "90th_percentile": 2399.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2399.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2399.19, "10th_percentile": 2399.19, "90th_percentile": 2399.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2399.19, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2399.19, "10th_percentile": 2399.19, "90th_percentile": 2399.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1685.01, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1685.01, "10th_percentile": 1685.01, "90th_percentile": 1685.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1685.01, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1685.01, "10th_percentile": 1685.01, "90th_percentile": 1685.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1685.01, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1685.01, "10th_percentile": 1685.01, "90th_percentile": 1685.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2789.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2789.75, "10th_percentile": 2789.75, "90th_percentile": 2789.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2789.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2789.75, "10th_percentile": 2789.75, "90th_percentile": 2789.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1852.12, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1852.12, "10th_percentile": 1852.12, "90th_percentile": 1852.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1852.12, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1852.12, "10th_percentile": 1852.12, "90th_percentile": 1852.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1980.72, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1980.72, "10th_percentile": 1980.72, "90th_percentile": 1980.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1980.72, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1980.72, "10th_percentile": 1980.72, "90th_percentile": 1980.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 510.52, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 510.52, "10th_percentile": 510.52, "90th_percentile": 510.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 948.52, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 948.52, "10th_percentile": 948.52, "90th_percentile": 948.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 1001.52, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 1001.52, "10th_percentile": 1001.52, "90th_percentile": 1001.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2789.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2789.75, "10th_percentile": 2789.75, "90th_percentile": 2789.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2109.05, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2109.05, "10th_percentile": 2109.05, "90th_percentile": 2109.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2092.31, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2092.31, "10th_percentile": 2092.31, "90th_percentile": 2092.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2789.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2789.75, "10th_percentile": 2789.75, "90th_percentile": 2789.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2566.57, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2566.57, "10th_percentile": 2566.57, "90th_percentile": 2566.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1255.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1255.39, "10th_percentile": 1255.39, "90th_percentile": 1255.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 2176.01, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 2176.01, "10th_percentile": 2176.01, "90th_percentile": 2176.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1559.47, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1559.47, "10th_percentile": 1559.47, "90th_percentile": 1559.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "CARFILZOMIB 60 MG IV SOLR", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-195636", "type": "CDM" }, { "code": "J9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "76075-0101-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 2703.6, "maximum": 14773.75, "setting": "outpatient", "gross_charge": 14773.75, "discounted_cash": 10341.62, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14773.75, "10th_percentile": 14773.75, "90th_percentile": 14773.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 11.5% = $1,698.98 due to $0.00 Claim Price", "median_amount": 27.82, "10th_percentile": 27.82, "90th_percentile": 27.82, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 11.5% = $1,698.98 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 11.5% = $1,698.98 due to $0.00 Claim Price", "median_amount": 27.82, "10th_percentile": 27.82, "90th_percentile": 27.82, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 11.5% = $1,698.98 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1019.39, "10th_percentile": 1019.39, "90th_percentile": 1019.39, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1019.39, "10th_percentile": 1019.39, "90th_percentile": 1019.39, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1019.39, "10th_percentile": 1019.39, "90th_percentile": 1019.39, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1019.39, "10th_percentile": 1019.39, "90th_percentile": 1019.39, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1019.39, "10th_percentile": 1019.39, "90th_percentile": 1019.39, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1019.39, "10th_percentile": 1019.39, "90th_percentile": 1019.39, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1019.39, "10th_percentile": 1019.39, "90th_percentile": 1019.39, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,773.75 @ 6.9% = $1,019.39 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 14773.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 14773.75, "10th_percentile": 14773.75, "90th_percentile": 14773.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 8258.53, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8258.53, "10th_percentile": 8258.53, "90th_percentile": 8258.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 11168.96, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 11168.96, "10th_percentile": 11168.96, "90th_percentile": 11168.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 6648.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 6648.19, "10th_percentile": 6648.19, "90th_percentile": 6648.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14773.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14773.75, "10th_percentile": 14773.75, "90th_percentile": 14773.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 13591.85, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 13591.85, "10th_percentile": 13591.85, "90th_percentile": 13591.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 5303.78, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 5303.78, "10th_percentile": 5303.78, "90th_percentile": 5303.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 2703.6, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 2703.6, "10th_percentile": 2703.6, "90th_percentile": 2703.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 5023.08, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 5023.08, "10th_percentile": 5023.08, "90th_percentile": 5023.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 11080.31, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 11080.31, "10th_percentile": 11080.31, "90th_percentile": 11080.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 11523.53, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 11523.53, "10th_percentile": 11523.53, "90th_percentile": 11523.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10489.36, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10489.36, "10th_percentile": 10489.36, "90th_percentile": 10489.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10489.36, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10489.36, "10th_percentile": 10489.36, "90th_percentile": 10489.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14773.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14773.75, "10th_percentile": 14773.75, "90th_percentile": 14773.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14773.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14773.75, "10th_percentile": 14773.75, "90th_percentile": 14773.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9808.29, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9808.29, "10th_percentile": 9808.29, "90th_percentile": 9808.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9808.29, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9808.29, "10th_percentile": 9808.29, "90th_percentile": 9808.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8923.35, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8923.35, "10th_percentile": 8923.35, "90th_percentile": 8923.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8923.35, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8923.35, "10th_percentile": 8923.35, "90th_percentile": 8923.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 8923.35, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8923.35, "10th_percentile": 8923.35, "90th_percentile": 8923.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12705.43, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12705.43, "10th_percentile": 12705.43, "90th_percentile": 12705.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12705.43, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12705.43, "10th_percentile": 12705.43, "90th_percentile": 12705.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12705.43, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12705.43, "10th_percentile": 12705.43, "90th_percentile": 12705.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12705.43, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12705.43, "10th_percentile": 12705.43, "90th_percentile": 12705.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" } ] } ] }, { "description": "CAROITID WALLSTENT 8MM X 36MM X 135CM ENDOPROS SLFE XP TRCHBR R", "code_information": [ { "code": "SUP-312036", "type": "CDM" }, { "code": "C1876", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2676.13, "maximum": 14623.64, "setting": "outpatient", "gross_charge": 14623.64, "discounted_cash": 10236.55, "payers_information": [ { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 14623.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 11406.44, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 11406.44, "10th_percentile": 11406.44, "90th_percentile": 11406.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 13453.75, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 13453.75, "10th_percentile": 13453.75, "90th_percentile": 13453.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14623.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 6580.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 6580.64, "10th_percentile": 6580.64, "90th_percentile": 6580.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 11055.47, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 11055.47, "10th_percentile": 11055.47, "90th_percentile": 11055.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 8174.61, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8174.61, "10th_percentile": 8174.61, "90th_percentile": 8174.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 7706.66, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7706.66, "10th_percentile": 7706.66, "90th_percentile": 7706.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 9505.37, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 9505.37, "10th_percentile": 9505.37, "90th_percentile": 9505.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 7765.15, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7765.15, "10th_percentile": 7765.15, "90th_percentile": 7765.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 9783.22, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9783.22, "10th_percentile": 9783.22, "90th_percentile": 9783.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 7341.07, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7341.07, "10th_percentile": 7341.07, "90th_percentile": 7341.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 10967.73, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 10967.73, "10th_percentile": 10967.73, "90th_percentile": 10967.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 2676.13, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 2676.13, "10th_percentile": 2676.13, "90th_percentile": 2676.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 10982.35, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10982.35, "10th_percentile": 10982.35, "90th_percentile": 10982.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 5249.89, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 5249.89, "10th_percentile": 5249.89, "90th_percentile": 5249.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 4972.04, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 4972.04, "10th_percentile": 4972.04, "90th_percentile": 4972.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 9856.33, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9856.33, "10th_percentile": 9856.33, "90th_percentile": 9856.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14623.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14623.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9708.63, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9708.63, "10th_percentile": 9708.63, "90th_percentile": 9708.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9708.63, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9708.63, "10th_percentile": 9708.63, "90th_percentile": 9708.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10382.78, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10382.78, "10th_percentile": 10382.78, "90th_percentile": 10382.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10382.78, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10382.78, "10th_percentile": 10382.78, "90th_percentile": 10382.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8832.68, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8832.68, "10th_percentile": 8832.68, "90th_percentile": 8832.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 8832.68, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8832.68, "10th_percentile": 8832.68, "90th_percentile": 8832.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8832.68, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8832.68, "10th_percentile": 8832.68, "90th_percentile": 8832.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12576.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12576.33, "10th_percentile": 12576.33, "90th_percentile": 12576.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12576.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12576.33, "10th_percentile": 12576.33, "90th_percentile": 12576.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12576.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12576.33, "10th_percentile": 12576.33, "90th_percentile": 12576.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12576.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12576.33, "10th_percentile": 12576.33, "90th_percentile": 12576.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 11.5% = $1,681.72 due to $0.00 Claim Price", "median_amount": 1681.72, "10th_percentile": 1681.72, "90th_percentile": 1681.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 11.5% = $1,681.72 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 11.5% = $1,681.72 due to $0.00 Claim Price", "median_amount": 1681.72, "10th_percentile": 1681.72, "90th_percentile": 1681.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 11.5% = $1,681.72 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CAROTID STENT 6MM X 22MM X 135CM ENDOPROS SLFEXP TRCHBR R", "code_information": [ { "code": "SUP-312033", "type": "CDM" }, { "code": "C1876", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2676.13, "maximum": 14623.64, "setting": "outpatient", "gross_charge": 14623.64, "discounted_cash": 10236.55, "payers_information": [ { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 14623.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 11406.44, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 11406.44, "10th_percentile": 11406.44, "90th_percentile": 11406.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 13453.75, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 13453.75, "10th_percentile": 13453.75, "90th_percentile": 13453.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14623.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 6580.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 6580.64, "10th_percentile": 6580.64, "90th_percentile": 6580.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 11055.47, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 11055.47, "10th_percentile": 11055.47, "90th_percentile": 11055.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 8174.61, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8174.61, "10th_percentile": 8174.61, "90th_percentile": 8174.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 7706.66, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7706.66, "10th_percentile": 7706.66, "90th_percentile": 7706.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 9505.37, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 9505.37, "10th_percentile": 9505.37, "90th_percentile": 9505.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 7765.15, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7765.15, "10th_percentile": 7765.15, "90th_percentile": 7765.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 9783.22, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9783.22, "10th_percentile": 9783.22, "90th_percentile": 9783.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 7341.07, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7341.07, "10th_percentile": 7341.07, "90th_percentile": 7341.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 10967.73, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 10967.73, "10th_percentile": 10967.73, "90th_percentile": 10967.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 2676.13, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 2676.13, "10th_percentile": 2676.13, "90th_percentile": 2676.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 10982.35, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10982.35, "10th_percentile": 10982.35, "90th_percentile": 10982.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 5249.89, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 5249.89, "10th_percentile": 5249.89, "90th_percentile": 5249.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 4972.04, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 4972.04, "10th_percentile": 4972.04, "90th_percentile": 4972.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 9856.33, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9856.33, "10th_percentile": 9856.33, "90th_percentile": 9856.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14623.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14623.64, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9708.63, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9708.63, "10th_percentile": 9708.63, "90th_percentile": 9708.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 9708.63, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 9708.63, "10th_percentile": 9708.63, "90th_percentile": 9708.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10382.78, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10382.78, "10th_percentile": 10382.78, "90th_percentile": 10382.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 10382.78, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10382.78, "10th_percentile": 10382.78, "90th_percentile": 10382.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8832.68, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8832.68, "10th_percentile": 8832.68, "90th_percentile": 8832.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 8832.68, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8832.68, "10th_percentile": 8832.68, "90th_percentile": 8832.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8832.68, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8832.68, "10th_percentile": 8832.68, "90th_percentile": 8832.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12576.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12576.33, "10th_percentile": 12576.33, "90th_percentile": 12576.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12576.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12576.33, "10th_percentile": 12576.33, "90th_percentile": 12576.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12576.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12576.33, "10th_percentile": 12576.33, "90th_percentile": 12576.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 12576.33, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 12576.33, "10th_percentile": 12576.33, "90th_percentile": 12576.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1009.03, "10th_percentile": 1009.03, "90th_percentile": 1009.03, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 6.9% = $1,009.03 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 11.5% = $1,681.72 due to $0.00 Claim Price", "median_amount": 1681.72, "10th_percentile": 1681.72, "90th_percentile": 1681.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 11.5% = $1,681.72 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 11.5% = $1,681.72 due to $0.00 Claim Price", "median_amount": 1681.72, "10th_percentile": 1681.72, "90th_percentile": 1681.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,623.64 @ 11.5% = $1,681.72 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14623.64, "10th_percentile": 14623.64, "90th_percentile": 14623.64, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CARVEDILOL 3.125 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-18551", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "51079-0771-20", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.19, "maximum": 6.5, "setting": "outpatient", "gross_charge": 6.5, "discounted_cash": 4.55, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5.59, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5.59, "10th_percentile": 5.59, "90th_percentile": 5.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5.59, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5.59, "10th_percentile": 5.59, "90th_percentile": 5.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5.59, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5.59, "10th_percentile": 5.59, "90th_percentile": 5.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5.59, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5.59, "10th_percentile": 5.59, "90th_percentile": 5.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3.81, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.81, "10th_percentile": 3.81, "90th_percentile": 3.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3.81, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.81, "10th_percentile": 3.81, "90th_percentile": 3.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 4.32, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 4.32, "10th_percentile": 4.32, "90th_percentile": 4.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3.63, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.63, "10th_percentile": 3.63, "90th_percentile": 3.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4.97, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.97, "10th_percentile": 4.97, "90th_percentile": 4.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 2.33, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 2.33, "10th_percentile": 2.33, "90th_percentile": 2.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.19, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1.19, "10th_percentile": 1.19, "90th_percentile": 1.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 4.88, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.88, "10th_percentile": 4.88, "90th_percentile": 4.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 4.38, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.38, "10th_percentile": 4.38, "90th_percentile": 4.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 2.21, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 2.21, "10th_percentile": 2.21, "90th_percentile": 2.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 6.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 6.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 3.45, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.45, "10th_percentile": 3.45, "90th_percentile": 3.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 3.26, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.26, "10th_percentile": 3.26, "90th_percentile": 3.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 4.23, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 4.23, "10th_percentile": 4.23, "90th_percentile": 4.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 2.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 4.88, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 4.88, "10th_percentile": 4.88, "90th_percentile": 4.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 5.07, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 5.07, "10th_percentile": 5.07, "90th_percentile": 5.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 4.91, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 4.91, "10th_percentile": 4.91, "90th_percentile": 4.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 4.32, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 4.32, "10th_percentile": 4.32, "90th_percentile": 4.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 3.43, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.43, "10th_percentile": 3.43, "90th_percentile": 3.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 4.35, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.35, "10th_percentile": 4.35, "90th_percentile": 4.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 5.98, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 5.98, "10th_percentile": 5.98, "90th_percentile": 5.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4.97, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4.97, "10th_percentile": 4.97, "90th_percentile": 4.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "CARVEDILOL 6.25 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-15747", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "68001-0154-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.37, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.17, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.17, "10th_percentile": 1.17, "90th_percentile": 1.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.17, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.17, "10th_percentile": 1.17, "90th_percentile": 1.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.33, "10th_percentile": 1.33, "90th_percentile": 1.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.23, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.23, "10th_percentile": 1.23, "90th_percentile": 1.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.12, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.12, "10th_percentile": 1.12, "90th_percentile": 1.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.53, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.53, "10th_percentile": 1.53, "90th_percentile": 1.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 0.72, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 0.72, "10th_percentile": 0.72, "90th_percentile": 0.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.37, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.37, "10th_percentile": 0.37, "90th_percentile": 0.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1.35, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.35, "10th_percentile": 1.35, "90th_percentile": 1.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 0.68, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1.06, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.06, "10th_percentile": 1.06, "90th_percentile": 1.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1.3, "10th_percentile": 1.3, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1.5, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1.56, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1.56, "10th_percentile": 1.56, "90th_percentile": 1.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1.51, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1.51, "10th_percentile": 1.51, "90th_percentile": 1.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.33, "10th_percentile": 1.33, "90th_percentile": 1.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1.05, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1.34, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.34, "10th_percentile": 1.34, "90th_percentile": 1.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1.84, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1.84, "10th_percentile": 1.84, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.53, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.53, "10th_percentile": 1.53, "90th_percentile": 1.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." } ] } ] }, { "description": "CARVEDILOL 12.5 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-15749", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "68001-0151-00", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.37, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1.3, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1.3, "10th_percentile": 1.3, "90th_percentile": 1.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1.5, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1.0, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1.84, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1.84, "10th_percentile": 1.84, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1.56, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1.56, "10th_percentile": 1.56, "90th_percentile": 1.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1.34, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.34, "10th_percentile": 1.34, "90th_percentile": 1.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.12, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.12, "10th_percentile": 1.12, "90th_percentile": 1.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1.51, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1.51, "10th_percentile": 1.51, "90th_percentile": 1.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.37, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 0.37, "10th_percentile": 0.37, "90th_percentile": 0.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 0.68, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 0.72, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 0.72, "10th_percentile": 0.72, "90th_percentile": 0.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1.5, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1.35, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.35, "10th_percentile": 1.35, "90th_percentile": 1.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.33, "10th_percentile": 1.33, "90th_percentile": 1.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1.33, "10th_percentile": 1.33, "90th_percentile": 1.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.42, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.42, "10th_percentile": 1.42, "90th_percentile": 1.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1.42, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.42, "10th_percentile": 1.42, "90th_percentile": 1.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.21, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.21, "10th_percentile": 1.21, "90th_percentile": 1.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.21, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.21, "10th_percentile": 1.21, "90th_percentile": 1.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.21, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.21, "10th_percentile": 1.21, "90th_percentile": 1.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1.72, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.14, "10th_percentile": 0.14, "90th_percentile": 0.14, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.14, "10th_percentile": 0.14, "90th_percentile": 0.14, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.14, "10th_percentile": 0.14, "90th_percentile": 0.14, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.14, "10th_percentile": 0.14, "90th_percentile": 0.14, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.14, "10th_percentile": 0.14, "90th_percentile": 0.14, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.14, "10th_percentile": 0.14, "90th_percentile": 0.14, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.14, "10th_percentile": 0.14, "90th_percentile": 0.14, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.9% = $0.14 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 11.5% = $0.23 due to $0.00 Claim Price", "median_amount": 0.23, "10th_percentile": 0.23, "90th_percentile": 0.23, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 11.5% = $0.23 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 11.5% = $0.23 due to $0.00 Claim Price", "median_amount": 0.23, "10th_percentile": 0.23, "90th_percentile": 0.23, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 11.5% = $0.23 due to $0.00 Claim Price" } ] } ] }, { "description": "CATH 5FR DUAL POWERPIC SOLO", "code_information": [ { "code": "SUP-317522", "type": "CDM" }, { "code": "C1751", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 208.28, "maximum": 1138.14, "setting": "outpatient", "gross_charge": 1138.14, "discounted_cash": 796.7, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 978.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 978.8, "10th_percentile": 978.8, "90th_percentile": 978.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 978.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 978.8, "10th_percentile": 978.8, "90th_percentile": 978.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 978.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 978.8, "10th_percentile": 978.8, "90th_percentile": 978.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 978.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 978.8, "10th_percentile": 978.8, "90th_percentile": 978.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 687.44, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 687.44, "10th_percentile": 687.44, "90th_percentile": 687.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 687.44, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 687.44, "10th_percentile": 687.44, "90th_percentile": 687.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 687.44, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 687.44, "10th_percentile": 687.44, "90th_percentile": 687.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 755.61, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 755.61, "10th_percentile": 755.61, "90th_percentile": 755.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 755.61, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 755.61, "10th_percentile": 755.61, "90th_percentile": 755.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 808.08, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 808.08, "10th_percentile": 808.08, "90th_percentile": 808.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 808.08, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 808.08, "10th_percentile": 808.08, "90th_percentile": 808.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1138.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1138.14, "10th_percentile": 1138.14, "90th_percentile": 1138.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1138.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1138.14, "10th_percentile": 1138.14, "90th_percentile": 1138.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 767.11, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 767.11, "10th_percentile": 767.11, "90th_percentile": 767.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 854.74, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 854.74, "10th_percentile": 854.74, "90th_percentile": 854.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 386.97, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 386.97, "10th_percentile": 386.97, "90th_percentile": 386.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 408.59, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 408.59, "10th_percentile": 408.59, "90th_percentile": 408.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 208.28, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 208.28, "10th_percentile": 208.28, "90th_percentile": 208.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 512.16, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 512.16, "10th_percentile": 512.16, "90th_percentile": 512.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 636.22, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 636.22, "10th_percentile": 636.22, "90th_percentile": 636.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1138.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1138.14, "10th_percentile": 1138.14, "90th_percentile": 1138.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 739.79, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 739.79, "10th_percentile": 739.79, "90th_percentile": 739.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 604.35, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 604.35, "10th_percentile": 604.35, "90th_percentile": 604.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1138.14, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1138.14, "10th_percentile": 1138.14, "90th_percentile": 1138.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 571.35, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 571.35, "10th_percentile": 571.35, "90th_percentile": 571.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1047.09, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1047.09, "10th_percentile": 1047.09, "90th_percentile": 1047.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 761.42, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 761.42, "10th_percentile": 761.42, "90th_percentile": 761.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 860.43, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 860.43, "10th_percentile": 860.43, "90th_percentile": 860.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 887.75, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 887.75, "10th_percentile": 887.75, "90th_percentile": 887.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 853.61, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 853.61, "10th_percentile": 853.61, "90th_percentile": 853.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 599.8, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 599.8, "10th_percentile": 599.8, "90th_percentile": 599.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.53, "10th_percentile": 78.53, "90th_percentile": 78.53, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.53, "10th_percentile": 78.53, "90th_percentile": 78.53, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.53, "10th_percentile": 78.53, "90th_percentile": 78.53, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.53, "10th_percentile": 78.53, "90th_percentile": 78.53, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.53, "10th_percentile": 78.53, "90th_percentile": 78.53, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.53, "10th_percentile": 78.53, "90th_percentile": 78.53, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.53, "10th_percentile": 78.53, "90th_percentile": 78.53, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 6.9% = $78.53 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 11.5% = $130.89 due to $0.00 Claim Price", "median_amount": 130.89, "10th_percentile": 130.89, "90th_percentile": 130.89, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 11.5% = $130.89 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 11.5% = $130.89 due to $0.00 Claim Price", "median_amount": 130.89, "10th_percentile": 130.89, "90th_percentile": 130.89, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,138.14 @ 11.5% = $130.89 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1138.14, "10th_percentile": 1138.14, "90th_percentile": 1138.14, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ABLAT LG CRV 4MM TIP QPLR", "code_information": [ { "code": "SUP-301880", "type": "CDM" }, { "code": "C1733", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1038.8, "maximum": 5676.51, "setting": "outpatient", "gross_charge": 5676.51, "discounted_cash": 3973.56, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5676.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5676.51, "10th_percentile": 5676.51, "90th_percentile": 5676.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5676.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5676.51, "10th_percentile": 5676.51, "90th_percentile": 5676.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4030.32, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4030.32, "10th_percentile": 4030.32, "90th_percentile": 4030.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4030.32, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4030.32, "10th_percentile": 4030.32, "90th_percentile": 4030.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1038.8, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1038.8, "10th_percentile": 1038.8, "90th_percentile": 1038.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 1930.01, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 1930.01, "10th_percentile": 1930.01, "90th_percentile": 1930.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 2037.87, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 2037.87, "10th_percentile": 2037.87, "90th_percentile": 2037.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 4263.06, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4263.06, "10th_percentile": 4263.06, "90th_percentile": 4263.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 3825.97, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3825.97, "10th_percentile": 3825.97, "90th_percentile": 3825.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 4291.44, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 4291.44, "10th_percentile": 4291.44, "90th_percentile": 4291.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 3014.23, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3014.23, "10th_percentile": 3014.23, "90th_percentile": 3014.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 2991.52, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2991.52, "10th_percentile": 2991.52, "90th_percentile": 2991.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 5222.39, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 5222.39, "10th_percentile": 5222.39, "90th_percentile": 5222.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 2554.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 2554.43, "10th_percentile": 2554.43, "90th_percentile": 2554.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 4257.38, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 4257.38, "10th_percentile": 4257.38, "90th_percentile": 4257.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 4427.68, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 4427.68, "10th_percentile": 4427.68, "90th_percentile": 4427.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 5676.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 5676.51, "10th_percentile": 5676.51, "90th_percentile": 5676.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 3689.73, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 3689.73, "10th_percentile": 3689.73, "90th_percentile": 3689.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 2849.61, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2849.61, "10th_percentile": 2849.61, "90th_percentile": 2849.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 3797.59, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3797.59, "10th_percentile": 3797.59, "90th_percentile": 3797.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 5676.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 5676.51, "10th_percentile": 5676.51, "90th_percentile": 5676.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3173.17, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3173.17, "10th_percentile": 3173.17, "90th_percentile": 3173.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 3768.63, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 3768.63, "10th_percentile": 3768.63, "90th_percentile": 3768.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 3768.63, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 3768.63, "10th_percentile": 3768.63, "90th_percentile": 3768.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3428.61, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3428.61, "10th_percentile": 3428.61, "90th_percentile": 3428.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3428.61, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3428.61, "10th_percentile": 3428.61, "90th_percentile": 3428.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3428.61, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3428.61, "10th_percentile": 3428.61, "90th_percentile": 3428.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4881.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4881.8, "10th_percentile": 4881.8, "90th_percentile": 4881.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4881.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4881.8, "10th_percentile": 4881.8, "90th_percentile": 4881.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4881.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4881.8, "10th_percentile": 4881.8, "90th_percentile": 4881.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 4881.8, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 4881.8, "10th_percentile": 4881.8, "90th_percentile": 4881.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.68, "10th_percentile": 391.68, "90th_percentile": 391.68, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.68, "10th_percentile": 391.68, "90th_percentile": 391.68, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.68, "10th_percentile": 391.68, "90th_percentile": 391.68, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.68, "10th_percentile": 391.68, "90th_percentile": 391.68, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.68, "10th_percentile": 391.68, "90th_percentile": 391.68, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.68, "10th_percentile": 391.68, "90th_percentile": 391.68, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 391.68, "10th_percentile": 391.68, "90th_percentile": 391.68, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 6.9% = $391.68 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 11.5% = $652.80 due to $0.00 Claim Price", "median_amount": 652.8, "10th_percentile": 652.8, "90th_percentile": 652.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 11.5% = $652.80 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 11.5% = $652.80 due to $0.00 Claim Price", "median_amount": 652.8, "10th_percentile": 652.8, "90th_percentile": 652.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,676.51 @ 11.5% = $652.80 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5676.51, "10th_percentile": 5676.51, "90th_percentile": 5676.51, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BALLN DILAT PTA ULT", "code_information": [ { "code": "SUP-337514", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 118.3, "maximum": 646.45, "setting": "outpatient", "gross_charge": 646.45, "discounted_cash": 452.51, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 429.18, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 429.18, "10th_percentile": 429.18, "90th_percentile": 429.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 429.18, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 429.18, "10th_percentile": 429.18, "90th_percentile": 429.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 458.98, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 458.98, "10th_percentile": 458.98, "90th_percentile": 458.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 458.98, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 458.98, "10th_percentile": 458.98, "90th_percentile": 458.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 232.08, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 232.08, "10th_percentile": 232.08, "90th_percentile": 232.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 219.79, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 219.79, "10th_percentile": 219.79, "90th_percentile": 219.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 485.48, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 485.48, "10th_percentile": 485.48, "90th_percentile": 485.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 118.3, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 118.3, "10th_percentile": 118.3, "90th_percentile": 118.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 435.71, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 435.71, "10th_percentile": 435.71, "90th_percentile": 435.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 432.48, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 432.48, "10th_percentile": 432.48, "90th_percentile": 432.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 340.68, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 340.68, "10th_percentile": 340.68, "90th_percentile": 340.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 420.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 420.19, "10th_percentile": 420.19, "90th_percentile": 420.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 324.52, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 324.52, "10th_percentile": 324.52, "90th_percentile": 324.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 484.84, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 484.84, "10th_percentile": 484.84, "90th_percentile": 484.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 343.26, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 343.26, "10th_percentile": 343.26, "90th_percentile": 343.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 290.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 290.9, "10th_percentile": 290.9, "90th_percentile": 290.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 594.73, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 594.73, "10th_percentile": 594.73, "90th_percentile": 594.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 488.72, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 488.72, "10th_percentile": 488.72, "90th_percentile": 488.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 646.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 646.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 504.23, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 504.23, "10th_percentile": 504.23, "90th_percentile": 504.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 361.37, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 361.37, "10th_percentile": 361.37, "90th_percentile": 361.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 390.46, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 390.46, "10th_percentile": 390.46, "90th_percentile": 390.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 390.46, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 390.46, "10th_percentile": 390.46, "90th_percentile": 390.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 390.46, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 390.46, "10th_percentile": 390.46, "90th_percentile": 390.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 555.95, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 555.95, "10th_percentile": 555.95, "90th_percentile": 555.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 555.95, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 555.95, "10th_percentile": 555.95, "90th_percentile": 555.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 555.95, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 555.95, "10th_percentile": 555.95, "90th_percentile": 555.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 555.95, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 555.95, "10th_percentile": 555.95, "90th_percentile": 555.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 11.5% = $74.34 due to $0.00 Claim Price", "median_amount": 74.34, "10th_percentile": 74.34, "90th_percentile": 74.34, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 11.5% = $74.34 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 11.5% = $74.34 due to $0.00 Claim Price", "median_amount": 74.34, "10th_percentile": 74.34, "90th_percentile": 74.34, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 11.5% = $74.34 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BALLN DILAT PTA ULT", "code_information": [ { "code": "SUP-337517", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 118.3, "maximum": 646.45, "setting": "outpatient", "gross_charge": 646.45, "discounted_cash": 452.51, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 429.18, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 429.18, "10th_percentile": 429.18, "90th_percentile": 429.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 429.18, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 429.18, "10th_percentile": 429.18, "90th_percentile": 429.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 646.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 458.98, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 458.98, "10th_percentile": 458.98, "90th_percentile": 458.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 458.98, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 458.98, "10th_percentile": 458.98, "90th_percentile": 458.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 232.08, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 232.08, "10th_percentile": 232.08, "90th_percentile": 232.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 219.79, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 219.79, "10th_percentile": 219.79, "90th_percentile": 219.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 485.48, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 485.48, "10th_percentile": 485.48, "90th_percentile": 485.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 118.3, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 118.3, "10th_percentile": 118.3, "90th_percentile": 118.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 435.71, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 435.71, "10th_percentile": 435.71, "90th_percentile": 435.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 432.48, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 432.48, "10th_percentile": 432.48, "90th_percentile": 432.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 340.68, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 340.68, "10th_percentile": 340.68, "90th_percentile": 340.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 420.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 420.19, "10th_percentile": 420.19, "90th_percentile": 420.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 324.52, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 324.52, "10th_percentile": 324.52, "90th_percentile": 324.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 484.84, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 484.84, "10th_percentile": 484.84, "90th_percentile": 484.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 343.26, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 343.26, "10th_percentile": 343.26, "90th_percentile": 343.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 290.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 290.9, "10th_percentile": 290.9, "90th_percentile": 290.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 594.73, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 594.73, "10th_percentile": 594.73, "90th_percentile": 594.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 488.72, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 488.72, "10th_percentile": 488.72, "90th_percentile": 488.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 646.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 646.45, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 504.23, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 504.23, "10th_percentile": 504.23, "90th_percentile": 504.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 361.37, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 361.37, "10th_percentile": 361.37, "90th_percentile": 361.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 390.46, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 390.46, "10th_percentile": 390.46, "90th_percentile": 390.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 390.46, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 390.46, "10th_percentile": 390.46, "90th_percentile": 390.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 390.46, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 390.46, "10th_percentile": 390.46, "90th_percentile": 390.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 555.95, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 555.95, "10th_percentile": 555.95, "90th_percentile": 555.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 555.95, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 555.95, "10th_percentile": 555.95, "90th_percentile": 555.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 555.95, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 555.95, "10th_percentile": 555.95, "90th_percentile": 555.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 555.95, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 555.95, "10th_percentile": 555.95, "90th_percentile": 555.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 6.9% = $44.61 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 11.5% = $74.34 due to $0.00 Claim Price", "median_amount": 74.34, "10th_percentile": 74.34, "90th_percentile": 74.34, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 11.5% = $74.34 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 11.5% = $74.34 due to $0.00 Claim Price", "median_amount": 74.34, "10th_percentile": 74.34, "90th_percentile": 74.34, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $646.45 @ 11.5% = $74.34 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 646.45, "10th_percentile": 646.45, "90th_percentile": 646.45, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLLN DIL ELITE NANO", "code_information": [ { "code": "SUP-313840", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 178.66, "maximum": 976.3, "setting": "outpatient", "gross_charge": 976.3, "discounted_cash": 683.41, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 653.14, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 653.14, "10th_percentile": 653.14, "90th_percentile": 653.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 898.2, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 898.2, "10th_percentile": 898.2, "90th_percentile": 898.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 439.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 732.23, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 732.23, "10th_percentile": 732.23, "90th_percentile": 732.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 761.51, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 761.51, "10th_percentile": 761.51, "90th_percentile": 761.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 634.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 634.6, "10th_percentile": 634.6, "90th_percentile": 634.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 490.1, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 490.1, "10th_percentile": 490.1, "90th_percentile": 490.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 518.42, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 518.42, "10th_percentile": 518.42, "90th_percentile": 518.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 514.51, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 514.51, "10th_percentile": 514.51, "90th_percentile": 514.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 738.08, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 738.08, "10th_percentile": 738.08, "90th_percentile": 738.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 545.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.75, "10th_percentile": 545.75, "90th_percentile": 545.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 178.66, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 178.66, "10th_percentile": 178.66, "90th_percentile": 178.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 331.94, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 331.94, "10th_percentile": 331.94, "90th_percentile": 331.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 350.49, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 350.49, "10th_percentile": 350.49, "90th_percentile": 350.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 733.2, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 733.2, "10th_percentile": 733.2, "90th_percentile": 733.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 658.03, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 658.03, "10th_percentile": 658.03, "90th_percentile": 658.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 648.17, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 648.17, "10th_percentile": 648.17, "90th_percentile": 648.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 648.17, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 648.17, "10th_percentile": 648.17, "90th_percentile": 648.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 693.17, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 693.17, "10th_percentile": 693.17, "90th_percentile": 693.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 693.17, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 693.17, "10th_percentile": 693.17, "90th_percentile": 693.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLLN DIL OTW 6X250M", "code_information": [ { "code": "SUP-340258", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 163.35, "maximum": 892.62, "setting": "outpatient", "gross_charge": 892.62, "discounted_cash": 624.83, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 592.61, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 592.61, "10th_percentile": 592.61, "90th_percentile": 592.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 592.61, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 592.61, "10th_percentile": 592.61, "90th_percentile": 592.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 892.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 892.62, "10th_percentile": 892.62, "90th_percentile": 892.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 892.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 892.62, "10th_percentile": 892.62, "90th_percentile": 892.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 633.76, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 633.76, "10th_percentile": 633.76, "90th_percentile": 633.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 633.76, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 633.76, "10th_percentile": 633.76, "90th_percentile": 633.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 320.45, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 320.45, "10th_percentile": 320.45, "90th_percentile": 320.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 303.49, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 303.49, "10th_percentile": 303.49, "90th_percentile": 303.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 670.36, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 670.36, "10th_percentile": 670.36, "90th_percentile": 670.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 163.35, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 163.35, "10th_percentile": 163.35, "90th_percentile": 163.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 601.63, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 601.63, "10th_percentile": 601.63, "90th_percentile": 601.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 597.16, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.16, "10th_percentile": 597.16, "90th_percentile": 597.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 470.41, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 470.41, "10th_percentile": 470.41, "90th_percentile": 470.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 580.2, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 580.2, "10th_percentile": 580.2, "90th_percentile": 580.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 448.1, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 448.1, "10th_percentile": 448.1, "90th_percentile": 448.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 669.47, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 669.47, "10th_percentile": 669.47, "90th_percentile": 669.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 473.98, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 473.98, "10th_percentile": 473.98, "90th_percentile": 473.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 401.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 401.68, "10th_percentile": 401.68, "90th_percentile": 401.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 821.21, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 821.21, "10th_percentile": 821.21, "90th_percentile": 821.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 674.82, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 674.82, "10th_percentile": 674.82, "90th_percentile": 674.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 892.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 892.62, "10th_percentile": 892.62, "90th_percentile": 892.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 892.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 892.62, "10th_percentile": 892.62, "90th_percentile": 892.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 696.24, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 696.24, "10th_percentile": 696.24, "90th_percentile": 696.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 498.97, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 498.97, "10th_percentile": 498.97, "90th_percentile": 498.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 539.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 539.14, "10th_percentile": 539.14, "90th_percentile": 539.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 539.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 539.14, "10th_percentile": 539.14, "90th_percentile": 539.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 539.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 539.14, "10th_percentile": 539.14, "90th_percentile": 539.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 767.65, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 767.65, "10th_percentile": 767.65, "90th_percentile": 767.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 767.65, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 767.65, "10th_percentile": 767.65, "90th_percentile": 767.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 767.65, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 767.65, "10th_percentile": 767.65, "90th_percentile": 767.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 767.65, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 767.65, "10th_percentile": 767.65, "90th_percentile": 767.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.59, "10th_percentile": 61.59, "90th_percentile": 61.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.59, "10th_percentile": 61.59, "90th_percentile": 61.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.59, "10th_percentile": 61.59, "90th_percentile": 61.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.59, "10th_percentile": 61.59, "90th_percentile": 61.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.59, "10th_percentile": 61.59, "90th_percentile": 61.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.59, "10th_percentile": 61.59, "90th_percentile": 61.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.59, "10th_percentile": 61.59, "90th_percentile": 61.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 6.9% = $61.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 11.5% = $102.65 due to $0.00 Claim Price", "median_amount": 102.65, "10th_percentile": 102.65, "90th_percentile": 102.65, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 11.5% = $102.65 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 11.5% = $102.65 due to $0.00 Claim Price", "median_amount": 102.65, "10th_percentile": 102.65, "90th_percentile": 102.65, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $892.62 @ 11.5% = $102.65 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 892.62, "10th_percentile": 892.62, "90th_percentile": 892.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLLN DIL PERI OTW LUTONIX 6X40MMX75CM", "code_information": [ { "code": "SUP-349629", "type": "CDM" }, { "code": "C2623", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 2105.68, "maximum": 11506.44, "setting": "outpatient", "gross_charge": 11506.44, "discounted_cash": 8054.51, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11506.44, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11506.44, "10th_percentile": 11506.44, "90th_percentile": 11506.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11506.44, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11506.44, "10th_percentile": 11506.44, "90th_percentile": 11506.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 11506.44, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 11506.44, "10th_percentile": 11506.44, "90th_percentile": 11506.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 11506.44, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 11506.44, "10th_percentile": 11506.44, "90th_percentile": 11506.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 7755.34, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7755.34, "10th_percentile": 7755.34, "90th_percentile": 7755.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 8641.34, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8641.34, "10th_percentile": 8641.34, "90th_percentile": 8641.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 4130.81, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 4130.81, "10th_percentile": 4130.81, "90th_percentile": 4130.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 3912.19, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 3912.19, "10th_percentile": 3912.19, "90th_percentile": 3912.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 2105.68, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 2105.68, "10th_percentile": 2105.68, "90th_percentile": 2105.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 8169.57, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8169.57, "10th_percentile": 8169.57, "90th_percentile": 8169.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6432.1, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6432.1, "10th_percentile": 6432.1, "90th_percentile": 6432.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 8169.57, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8169.57, "10th_percentile": 8169.57, "90th_percentile": 8169.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 8698.87, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 8698.87, "10th_percentile": 8698.87, "90th_percentile": 8698.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 6109.92, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6109.92, "10th_percentile": 6109.92, "90th_percentile": 6109.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 6063.89, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6063.89, "10th_percentile": 6063.89, "90th_percentile": 6063.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 10585.92, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 10585.92, "10th_percentile": 10585.92, "90th_percentile": 10585.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 5177.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 5177.9, "10th_percentile": 5177.9, "90th_percentile": 5177.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 8629.83, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 8629.83, "10th_percentile": 8629.83, "90th_percentile": 8629.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 8975.02, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 8975.02, "10th_percentile": 8975.02, "90th_percentile": 8975.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 7479.19, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 7479.19, "10th_percentile": 7479.19, "90th_percentile": 7479.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 5776.23, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5776.23, "10th_percentile": 5776.23, "90th_percentile": 5776.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 7697.81, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7697.81, "10th_percentile": 7697.81, "90th_percentile": 7697.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 7639.13, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 7639.13, "10th_percentile": 7639.13, "90th_percentile": 7639.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 7639.13, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 7639.13, "10th_percentile": 7639.13, "90th_percentile": 7639.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 6949.89, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6949.89, "10th_percentile": 6949.89, "90th_percentile": 6949.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 6949.89, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6949.89, "10th_percentile": 6949.89, "90th_percentile": 6949.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 6949.89, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6949.89, "10th_percentile": 6949.89, "90th_percentile": 6949.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 9895.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 9895.54, "10th_percentile": 9895.54, "90th_percentile": 9895.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 9895.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 9895.54, "10th_percentile": 9895.54, "90th_percentile": 9895.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 9895.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 9895.54, "10th_percentile": 9895.54, "90th_percentile": 9895.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 9895.54, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 9895.54, "10th_percentile": 9895.54, "90th_percentile": 9895.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.94, "10th_percentile": 793.94, "90th_percentile": 793.94, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.94, "10th_percentile": 793.94, "90th_percentile": 793.94, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.94, "10th_percentile": 793.94, "90th_percentile": 793.94, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.94, "10th_percentile": 793.94, "90th_percentile": 793.94, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.94, "10th_percentile": 793.94, "90th_percentile": 793.94, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.94, "10th_percentile": 793.94, "90th_percentile": 793.94, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 793.94, "10th_percentile": 793.94, "90th_percentile": 793.94, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 6.9% = $793.94 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 11.5% = $1,323.24 due to $0.00 Claim Price", "median_amount": 1323.24, "10th_percentile": 1323.24, "90th_percentile": 1323.24, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 11.5% = $1,323.24 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 11.5% = $1,323.24 due to $0.00 Claim Price", "median_amount": 1323.24, "10th_percentile": 1323.24, "90th_percentile": 1323.24, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,506.44 @ 11.5% = $1,323.24 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11506.44, "10th_percentile": 11506.44, "90th_percentile": 11506.44, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLLN DIL PTA NC 3.5X210MMX150CM", "code_information": [ { "code": "SUP-354948", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 178.66, "maximum": 976.3, "setting": "outpatient", "gross_charge": 976.3, "discounted_cash": 683.41, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 653.14, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 653.14, "10th_percentile": 653.14, "90th_percentile": 653.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 898.2, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 898.2, "10th_percentile": 898.2, "90th_percentile": 898.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 439.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 732.23, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 732.23, "10th_percentile": 732.23, "90th_percentile": 732.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 761.51, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 761.51, "10th_percentile": 761.51, "90th_percentile": 761.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 634.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 634.6, "10th_percentile": 634.6, "90th_percentile": 634.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 490.1, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 490.1, "10th_percentile": 490.1, "90th_percentile": 490.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 518.42, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 518.42, "10th_percentile": 518.42, "90th_percentile": 518.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 514.51, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 514.51, "10th_percentile": 514.51, "90th_percentile": 514.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 738.08, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 738.08, "10th_percentile": 738.08, "90th_percentile": 738.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 545.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.75, "10th_percentile": 545.75, "90th_percentile": 545.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 178.66, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 178.66, "10th_percentile": 178.66, "90th_percentile": 178.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 331.94, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 331.94, "10th_percentile": 331.94, "90th_percentile": 331.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 350.49, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 350.49, "10th_percentile": 350.49, "90th_percentile": 350.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 733.2, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 733.2, "10th_percentile": 733.2, "90th_percentile": 733.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 658.03, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 658.03, "10th_percentile": 658.03, "90th_percentile": 658.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 648.17, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 648.17, "10th_percentile": 648.17, "90th_percentile": 648.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 648.17, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 648.17, "10th_percentile": 648.17, "90th_percentile": 648.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 693.17, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 693.17, "10th_percentile": 693.17, "90th_percentile": 693.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 693.17, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 693.17, "10th_percentile": 693.17, "90th_percentile": 693.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLLN DIL PTA OTW AN", "code_information": [ { "code": "SUP-322638", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1148.55, "maximum": 6276.24, "setting": "outpatient", "gross_charge": 6276.24, "discounted_cash": 4393.37, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 4166.8, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 4166.8, "10th_percentile": 4166.8, "90th_percentile": 4166.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 4166.8, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 4166.8, "10th_percentile": 4166.8, "90th_percentile": 4166.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6276.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6276.24, "10th_percentile": 6276.24, "90th_percentile": 6276.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6276.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6276.24, "10th_percentile": 6276.24, "90th_percentile": 6276.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4456.13, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4456.13, "10th_percentile": 4456.13, "90th_percentile": 4456.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4456.13, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4456.13, "10th_percentile": 4456.13, "90th_percentile": 4456.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 2253.17, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 2253.17, "10th_percentile": 2253.17, "90th_percentile": 2253.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 2133.92, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 2133.92, "10th_percentile": 2133.92, "90th_percentile": 2133.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 4713.46, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4713.46, "10th_percentile": 4713.46, "90th_percentile": 4713.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1148.55, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1148.55, "10th_percentile": 1148.55, "90th_percentile": 1148.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 4230.19, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4230.19, "10th_percentile": 4230.19, "90th_percentile": 4230.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 4198.8, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4198.8, "10th_percentile": 4198.8, "90th_percentile": 4198.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 3307.58, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3307.58, "10th_percentile": 3307.58, "90th_percentile": 3307.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 4079.56, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 4079.56, "10th_percentile": 4079.56, "90th_percentile": 4079.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 3150.67, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3150.67, "10th_percentile": 3150.67, "90th_percentile": 3150.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 4707.18, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 4707.18, "10th_percentile": 4707.18, "90th_percentile": 4707.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 3332.68, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3332.68, "10th_percentile": 3332.68, "90th_percentile": 3332.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 2824.31, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 2824.31, "10th_percentile": 2824.31, "90th_percentile": 2824.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 5774.14, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 5774.14, "10th_percentile": 5774.14, "90th_percentile": 5774.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 4744.84, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 4744.84, "10th_percentile": 4744.84, "90th_percentile": 4744.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 6276.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 6276.24, "10th_percentile": 6276.24, "90th_percentile": 6276.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 6276.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 6276.24, "10th_percentile": 6276.24, "90th_percentile": 6276.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 4895.47, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 4895.47, "10th_percentile": 4895.47, "90th_percentile": 4895.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3508.42, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3508.42, "10th_percentile": 3508.42, "90th_percentile": 3508.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3790.85, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3790.85, "10th_percentile": 3790.85, "90th_percentile": 3790.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3790.85, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3790.85, "10th_percentile": 3790.85, "90th_percentile": 3790.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3790.85, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3790.85, "10th_percentile": 3790.85, "90th_percentile": 3790.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5397.57, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5397.57, "10th_percentile": 5397.57, "90th_percentile": 5397.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5397.57, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5397.57, "10th_percentile": 5397.57, "90th_percentile": 5397.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5397.57, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5397.57, "10th_percentile": 5397.57, "90th_percentile": 5397.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5397.57, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5397.57, "10th_percentile": 5397.57, "90th_percentile": 5397.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 433.06, "10th_percentile": 433.06, "90th_percentile": 433.06, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 433.06, "10th_percentile": 433.06, "90th_percentile": 433.06, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 433.06, "10th_percentile": 433.06, "90th_percentile": 433.06, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 433.06, "10th_percentile": 433.06, "90th_percentile": 433.06, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 433.06, "10th_percentile": 433.06, "90th_percentile": 433.06, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 433.06, "10th_percentile": 433.06, "90th_percentile": 433.06, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 433.06, "10th_percentile": 433.06, "90th_percentile": 433.06, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 6.9% = $433.06 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 11.5% = $721.77 due to $0.00 Claim Price", "median_amount": 721.77, "10th_percentile": 721.77, "90th_percentile": 721.77, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 11.5% = $721.77 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 11.5% = $721.77 due to $0.00 Claim Price", "median_amount": 721.77, "10th_percentile": 721.77, "90th_percentile": 721.77, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,276.24 @ 11.5% = $721.77 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6276.24, "10th_percentile": 6276.24, "90th_percentile": 6276.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLLN DIL PTXL PTA O", "code_information": [ { "code": "SUP-310423", "type": "CDM" }, { "code": "C2623", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1493.12, "maximum": 8159.11, "setting": "outpatient", "gross_charge": 8159.11, "discounted_cash": 5711.38, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8159.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8159.11, "10th_percentile": 8159.11, "90th_percentile": 8159.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 6168.29, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 6168.29, "10th_percentile": 6168.29, "90th_percentile": 6168.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 4332.49, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4332.49, "10th_percentile": 4332.49, "90th_percentile": 4332.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 4299.85, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4299.85, "10th_percentile": 4299.85, "90th_percentile": 4299.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 7506.38, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 7506.38, "10th_percentile": 7506.38, "90th_percentile": 7506.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 3671.6, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 3671.6, "10th_percentile": 3671.6, "90th_percentile": 3671.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 6119.33, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 6119.33, "10th_percentile": 6119.33, "90th_percentile": 6119.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 6364.11, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 6364.11, "10th_percentile": 6364.11, "90th_percentile": 6364.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 8159.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 8159.11, "10th_percentile": 8159.11, "90th_percentile": 8159.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 5303.42, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 5303.42, "10th_percentile": 5303.42, "90th_percentile": 5303.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 4095.87, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4095.87, "10th_percentile": 4095.87, "90th_percentile": 4095.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 5458.44, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5458.44, "10th_percentile": 5458.44, "90th_percentile": 5458.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 8159.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 8159.11, "10th_percentile": 8159.11, "90th_percentile": 8159.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8159.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8159.11, "10th_percentile": 8159.11, "90th_percentile": 8159.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 5499.24, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5499.24, "10th_percentile": 5499.24, "90th_percentile": 5499.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 6127.49, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6127.49, "10th_percentile": 6127.49, "90th_percentile": 6127.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 2929.12, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 2929.12, "10th_percentile": 2929.12, "90th_percentile": 2929.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 2774.1, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 2774.1, "10th_percentile": 2774.1, "90th_percentile": 2774.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1493.12, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1493.12, "10th_percentile": 1493.12, "90th_percentile": 1493.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 5792.97, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5792.97, "10th_percentile": 5792.97, "90th_percentile": 5792.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4560.94, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4560.94, "10th_percentile": 4560.94, "90th_percentile": 4560.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 5792.97, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5792.97, "10th_percentile": 5792.97, "90th_percentile": 5792.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5416.83, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5416.83, "10th_percentile": 5416.83, "90th_percentile": 5416.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5416.83, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5416.83, "10th_percentile": 5416.83, "90th_percentile": 5416.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 4928.1, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4928.1, "10th_percentile": 4928.1, "90th_percentile": 4928.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 4928.1, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4928.1, "10th_percentile": 4928.1, "90th_percentile": 4928.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4928.1, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4928.1, "10th_percentile": 4928.1, "90th_percentile": 4928.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7016.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7016.83, "10th_percentile": 7016.83, "90th_percentile": 7016.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7016.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7016.83, "10th_percentile": 7016.83, "90th_percentile": 7016.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7016.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7016.83, "10th_percentile": 7016.83, "90th_percentile": 7016.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7016.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7016.83, "10th_percentile": 7016.83, "90th_percentile": 7016.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 562.98, "10th_percentile": 562.98, "90th_percentile": 562.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 562.98, "10th_percentile": 562.98, "90th_percentile": 562.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 562.98, "10th_percentile": 562.98, "90th_percentile": 562.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 562.98, "10th_percentile": 562.98, "90th_percentile": 562.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 562.98, "10th_percentile": 562.98, "90th_percentile": 562.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 562.98, "10th_percentile": 562.98, "90th_percentile": 562.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 562.98, "10th_percentile": 562.98, "90th_percentile": 562.98, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 6.9% = $562.98 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 11.5% = $938.30 due to $0.00 Claim Price", "median_amount": 938.3, "10th_percentile": 938.3, "90th_percentile": 938.3, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 11.5% = $938.30 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 11.5% = $938.30 due to $0.00 Claim Price", "median_amount": 938.3, "10th_percentile": 938.3, "90th_percentile": 938.3, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,159.11 @ 11.5% = $938.30 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8159.11, "10th_percentile": 8159.11, "90th_percentile": 8159.11, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLLN DILTN PTCA RX MINI TREK 1.2X8 MM", "code_information": [ { "code": "SUP-318435", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 127.62, "maximum": 697.36, "setting": "outpatient", "gross_charge": 697.36, "discounted_cash": 488.15, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 389.82, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 389.82, "10th_percentile": 389.82, "90th_percentile": 389.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 527.2, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 527.2, "10th_percentile": 527.2, "90th_percentile": 527.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 370.3, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 370.3, "10th_percentile": 370.3, "90th_percentile": 370.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 367.51, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 367.51, "10th_percentile": 367.51, "90th_percentile": 367.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 466.53, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 466.53, "10th_percentile": 466.53, "90th_percentile": 466.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 523.02, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 523.02, "10th_percentile": 523.02, "90th_percentile": 523.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 543.94, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 543.94, "10th_percentile": 543.94, "90th_percentile": 543.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 313.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 350.07, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 350.07, "10th_percentile": 350.07, "90th_percentile": 350.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 453.28, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 453.28, "10th_percentile": 453.28, "90th_percentile": 453.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 641.57, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 641.57, "10th_percentile": 641.57, "90th_percentile": 641.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 470.02, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 470.02, "10th_percentile": 470.02, "90th_percentile": 470.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 523.72, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 523.72, "10th_percentile": 523.72, "90th_percentile": 523.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 250.35, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 250.35, "10th_percentile": 250.35, "90th_percentile": 250.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 237.1, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 237.1, "10th_percentile": 237.1, "90th_percentile": 237.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 127.62, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 127.62, "10th_percentile": 127.62, "90th_percentile": 127.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 462.98, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 462.98, "10th_percentile": 462.98, "90th_percentile": 462.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 462.98, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 462.98, "10th_percentile": 462.98, "90th_percentile": 462.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 495.13, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 495.13, "10th_percentile": 495.13, "90th_percentile": 495.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 495.13, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 495.13, "10th_percentile": 495.13, "90th_percentile": 495.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 697.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 697.36, "10th_percentile": 697.36, "90th_percentile": 697.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 697.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 697.36, "10th_percentile": 697.36, "90th_percentile": 697.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 697.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 697.36, "10th_percentile": 697.36, "90th_percentile": 697.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 697.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 697.36, "10th_percentile": 697.36, "90th_percentile": 697.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 421.21, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 421.21, "10th_percentile": 421.21, "90th_percentile": 421.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 421.21, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 421.21, "10th_percentile": 421.21, "90th_percentile": 421.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 421.21, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 421.21, "10th_percentile": 421.21, "90th_percentile": 421.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 599.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 599.73, "10th_percentile": 599.73, "90th_percentile": 599.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 599.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 599.73, "10th_percentile": 599.73, "90th_percentile": 599.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 599.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 599.73, "10th_percentile": 599.73, "90th_percentile": 599.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 599.73, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 599.73, "10th_percentile": 599.73, "90th_percentile": 599.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.12, "10th_percentile": 48.12, "90th_percentile": 48.12, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.12, "10th_percentile": 48.12, "90th_percentile": 48.12, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.12, "10th_percentile": 48.12, "90th_percentile": 48.12, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.12, "10th_percentile": 48.12, "90th_percentile": 48.12, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.12, "10th_percentile": 48.12, "90th_percentile": 48.12, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.12, "10th_percentile": 48.12, "90th_percentile": 48.12, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.12, "10th_percentile": 48.12, "90th_percentile": 48.12, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 6.9% = $48.12 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 11.5% = $80.20 due to $0.00 Claim Price", "median_amount": 80.2, "10th_percentile": 80.2, "90th_percentile": 80.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 11.5% = $80.20 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 11.5% = $80.20 due to $0.00 Claim Price", "median_amount": 80.2, "10th_percentile": 80.2, "90th_percentile": 80.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $697.36 @ 11.5% = $80.20 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 697.36, "10th_percentile": 697.36, "90th_percentile": 697.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLLN OCCL HYPERGLID", "code_information": [ { "code": "SUP-100380", "type": "CDM" }, { "code": "C2628", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1564.58, "maximum": 8549.63, "setting": "outpatient", "gross_charge": 8549.63, "discounted_cash": 5984.74, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8549.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8549.63, "10th_percentile": 8549.63, "90th_percentile": 8549.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8549.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8549.63, "10th_percentile": 8549.63, "90th_percentile": 8549.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 5762.45, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5762.45, "10th_percentile": 5762.45, "90th_percentile": 5762.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 6420.77, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6420.77, "10th_percentile": 6420.77, "90th_percentile": 6420.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 3069.32, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 3069.32, "10th_percentile": 3069.32, "90th_percentile": 3069.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 2906.87, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 2906.87, "10th_percentile": 2906.87, "90th_percentile": 2906.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1564.58, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1564.58, "10th_percentile": 1564.58, "90th_percentile": 1564.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 6070.24, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6070.24, "10th_percentile": 6070.24, "90th_percentile": 6070.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4779.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4779.24, "10th_percentile": 4779.24, "90th_percentile": 4779.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 6070.24, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6070.24, "10th_percentile": 6070.24, "90th_percentile": 6070.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 6463.52, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 6463.52, "10th_percentile": 6463.52, "90th_percentile": 6463.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 4539.85, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4539.85, "10th_percentile": 4539.85, "90th_percentile": 4539.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 4505.66, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4505.66, "10th_percentile": 4505.66, "90th_percentile": 4505.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 7865.66, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 7865.66, "10th_percentile": 7865.66, "90th_percentile": 7865.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 3847.33, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 3847.33, "10th_percentile": 3847.33, "90th_percentile": 3847.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 6412.22, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 6412.22, "10th_percentile": 6412.22, "90th_percentile": 6412.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 6668.71, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 6668.71, "10th_percentile": 6668.71, "90th_percentile": 6668.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 8549.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 8549.63, "10th_percentile": 8549.63, "90th_percentile": 8549.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 5557.26, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 5557.26, "10th_percentile": 5557.26, "90th_percentile": 5557.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 4291.91, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4291.91, "10th_percentile": 4291.91, "90th_percentile": 4291.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 5719.7, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5719.7, "10th_percentile": 5719.7, "90th_percentile": 5719.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 8549.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 8549.63, "10th_percentile": 8549.63, "90th_percentile": 8549.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5676.1, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5676.1, "10th_percentile": 5676.1, "90th_percentile": 5676.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 5676.1, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 5676.1, "10th_percentile": 5676.1, "90th_percentile": 5676.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 5163.98, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5163.98, "10th_percentile": 5163.98, "90th_percentile": 5163.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 5163.98, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5163.98, "10th_percentile": 5163.98, "90th_percentile": 5163.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5163.98, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5163.98, "10th_percentile": 5163.98, "90th_percentile": 5163.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7352.68, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7352.68, "10th_percentile": 7352.68, "90th_percentile": 7352.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7352.68, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7352.68, "10th_percentile": 7352.68, "90th_percentile": 7352.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7352.68, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7352.68, "10th_percentile": 7352.68, "90th_percentile": 7352.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 7352.68, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 7352.68, "10th_percentile": 7352.68, "90th_percentile": 7352.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.92, "10th_percentile": 589.92, "90th_percentile": 589.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.92, "10th_percentile": 589.92, "90th_percentile": 589.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.92, "10th_percentile": 589.92, "90th_percentile": 589.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.92, "10th_percentile": 589.92, "90th_percentile": 589.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.92, "10th_percentile": 589.92, "90th_percentile": 589.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.92, "10th_percentile": 589.92, "90th_percentile": 589.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.92, "10th_percentile": 589.92, "90th_percentile": 589.92, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 6.9% = $589.92 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 11.5% = $983.21 due to $0.00 Claim Price", "median_amount": 983.21, "10th_percentile": 983.21, "90th_percentile": 983.21, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 11.5% = $983.21 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 11.5% = $983.21 due to $0.00 Claim Price", "median_amount": 983.21, "10th_percentile": 983.21, "90th_percentile": 983.21, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,549.63 @ 11.5% = $983.21 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8549.63, "10th_percentile": 8549.63, "90th_percentile": 8549.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLN DIL EC 4X40MMX80CM", "code_information": [ { "code": "SUP-356243", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 81.67, "maximum": 446.31, "setting": "outpatient", "gross_charge": 446.31, "discounted_cash": 312.42, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 249.49, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 249.49, "10th_percentile": 249.49, "90th_percentile": 249.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 298.58, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 235.21, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 235.21, "10th_percentile": 235.21, "90th_percentile": 235.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 236.99, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 236.99, "10th_percentile": 236.99, "90th_percentile": 236.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 224.05, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.05, "10th_percentile": 224.05, "90th_percentile": 224.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 410.61, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 410.61, "10th_percentile": 410.61, "90th_percentile": 410.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 348.12, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 348.12, "10th_percentile": 348.12, "90th_percentile": 348.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 334.73, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 334.73, "10th_percentile": 334.73, "90th_percentile": 334.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 200.84, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 200.84, "10th_percentile": 200.84, "90th_percentile": 200.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 337.41, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 337.41, "10th_percentile": 337.41, "90th_percentile": 337.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 290.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 290.1, "10th_percentile": 290.1, "90th_percentile": 290.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 81.67, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 81.67, "10th_percentile": 81.67, "90th_percentile": 81.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 151.75, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 151.75, "10th_percentile": 151.75, "90th_percentile": 151.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 300.81, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 300.81, "10th_percentile": 300.81, "90th_percentile": 300.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 335.18, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 335.18, "10th_percentile": 335.18, "90th_percentile": 335.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 160.23, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 160.23, "10th_percentile": 160.23, "90th_percentile": 160.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 296.31, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 296.31, "10th_percentile": 296.31, "90th_percentile": 296.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 296.31, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 296.31, "10th_percentile": 296.31, "90th_percentile": 296.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 316.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.88, "10th_percentile": 316.88, "90th_percentile": 316.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 316.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.88, "10th_percentile": 316.88, "90th_percentile": 316.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price", "median_amount": 51.33, "10th_percentile": 51.33, "90th_percentile": 51.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price", "median_amount": 51.33, "10th_percentile": 51.33, "90th_percentile": 51.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLN DIL EC 5X20MMX80CM", "code_information": [ { "code": "SUP-356246", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 81.67, "maximum": 446.31, "setting": "outpatient", "gross_charge": 446.31, "discounted_cash": 312.42, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 249.49, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 249.49, "10th_percentile": 249.49, "90th_percentile": 249.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 298.58, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 235.21, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 235.21, "10th_percentile": 235.21, "90th_percentile": 235.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 236.99, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 236.99, "10th_percentile": 236.99, "90th_percentile": 236.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 224.05, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.05, "10th_percentile": 224.05, "90th_percentile": 224.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 410.61, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 410.61, "10th_percentile": 410.61, "90th_percentile": 410.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 348.12, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 348.12, "10th_percentile": 348.12, "90th_percentile": 348.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 334.73, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 334.73, "10th_percentile": 334.73, "90th_percentile": 334.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 200.84, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 200.84, "10th_percentile": 200.84, "90th_percentile": 200.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 337.41, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 337.41, "10th_percentile": 337.41, "90th_percentile": 337.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 290.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 290.1, "10th_percentile": 290.1, "90th_percentile": 290.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 81.67, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 81.67, "10th_percentile": 81.67, "90th_percentile": 81.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 151.75, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 151.75, "10th_percentile": 151.75, "90th_percentile": 151.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 300.81, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 300.81, "10th_percentile": 300.81, "90th_percentile": 300.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 335.18, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 335.18, "10th_percentile": 335.18, "90th_percentile": 335.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 160.23, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 160.23, "10th_percentile": 160.23, "90th_percentile": 160.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 296.31, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 296.31, "10th_percentile": 296.31, "90th_percentile": 296.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 296.31, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 296.31, "10th_percentile": 296.31, "90th_percentile": 296.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 316.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.88, "10th_percentile": 316.88, "90th_percentile": 316.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 316.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.88, "10th_percentile": 316.88, "90th_percentile": 316.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price", "median_amount": 51.33, "10th_percentile": 51.33, "90th_percentile": 51.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price", "median_amount": 51.33, "10th_percentile": 51.33, "90th_percentile": 51.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLN DIL EC 9X60MMX80CM", "code_information": [ { "code": "SUP-354968", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 81.67, "maximum": 446.31, "setting": "outpatient", "gross_charge": 446.31, "discounted_cash": 312.42, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 249.49, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 249.49, "10th_percentile": 249.49, "90th_percentile": 249.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 298.58, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 235.21, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 235.21, "10th_percentile": 235.21, "90th_percentile": 235.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 236.99, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 236.99, "10th_percentile": 236.99, "90th_percentile": 236.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 224.05, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.05, "10th_percentile": 224.05, "90th_percentile": 224.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 410.61, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 410.61, "10th_percentile": 410.61, "90th_percentile": 410.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 348.12, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 348.12, "10th_percentile": 348.12, "90th_percentile": 348.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 334.73, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 334.73, "10th_percentile": 334.73, "90th_percentile": 334.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 200.84, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 200.84, "10th_percentile": 200.84, "90th_percentile": 200.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 337.41, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 337.41, "10th_percentile": 337.41, "90th_percentile": 337.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 290.1, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 290.1, "10th_percentile": 290.1, "90th_percentile": 290.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 81.67, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 81.67, "10th_percentile": 81.67, "90th_percentile": 81.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 151.75, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 151.75, "10th_percentile": 151.75, "90th_percentile": 151.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 300.81, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 300.81, "10th_percentile": 300.81, "90th_percentile": 300.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 335.18, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 335.18, "10th_percentile": 335.18, "90th_percentile": 335.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 160.23, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 160.23, "10th_percentile": 160.23, "90th_percentile": 160.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 296.31, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 296.31, "10th_percentile": 296.31, "90th_percentile": 296.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 296.31, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 296.31, "10th_percentile": 296.31, "90th_percentile": 296.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 316.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.88, "10th_percentile": 316.88, "90th_percentile": 316.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 316.88, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 316.88, "10th_percentile": 316.88, "90th_percentile": 316.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 446.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 269.57, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 269.57, "10th_percentile": 269.57, "90th_percentile": 269.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 383.83, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 383.83, "10th_percentile": 383.83, "90th_percentile": 383.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 30.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 6.9% = $30.80 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price", "median_amount": 51.33, "10th_percentile": 51.33, "90th_percentile": 51.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price", "median_amount": 51.33, "10th_percentile": 51.33, "90th_percentile": 51.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $446.31 @ 11.5% = $51.33 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 446.31, "10th_percentile": 446.31, "90th_percentile": 446.31, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLN DIL NC 5X80MMX150CM", "code_information": [ { "code": "SUP-354950", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 178.66, "maximum": 976.3, "setting": "outpatient", "gross_charge": 976.3, "discounted_cash": 683.41, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 653.14, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 653.14, "10th_percentile": 653.14, "90th_percentile": 653.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 898.2, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 898.2, "10th_percentile": 898.2, "90th_percentile": 898.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 439.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 732.23, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 732.23, "10th_percentile": 732.23, "90th_percentile": 732.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 761.51, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 761.51, "10th_percentile": 761.51, "90th_percentile": 761.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 634.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 634.6, "10th_percentile": 634.6, "90th_percentile": 634.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 490.1, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 490.1, "10th_percentile": 490.1, "90th_percentile": 490.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 518.42, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 518.42, "10th_percentile": 518.42, "90th_percentile": 518.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 514.51, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 514.51, "10th_percentile": 514.51, "90th_percentile": 514.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 738.08, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 738.08, "10th_percentile": 738.08, "90th_percentile": 738.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 545.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.75, "10th_percentile": 545.75, "90th_percentile": 545.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 178.66, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 178.66, "10th_percentile": 178.66, "90th_percentile": 178.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 331.94, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 331.94, "10th_percentile": 331.94, "90th_percentile": 331.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 350.49, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 350.49, "10th_percentile": 350.49, "90th_percentile": 350.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 733.2, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 733.2, "10th_percentile": 733.2, "90th_percentile": 733.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 658.03, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 658.03, "10th_percentile": 658.03, "90th_percentile": 658.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 648.17, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 648.17, "10th_percentile": 648.17, "90th_percentile": 648.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 648.17, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 648.17, "10th_percentile": 648.17, "90th_percentile": 648.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 693.17, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 693.17, "10th_percentile": 693.17, "90th_percentile": 693.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 693.17, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 693.17, "10th_percentile": 693.17, "90th_percentile": 693.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLN DIL PTA NANOCRS 4X120MMX150CM", "code_information": [ { "code": "SUP-356261", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 178.66, "maximum": 976.3, "setting": "outpatient", "gross_charge": 976.3, "discounted_cash": 683.41, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 653.14, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 653.14, "10th_percentile": 653.14, "90th_percentile": 653.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 898.2, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 898.2, "10th_percentile": 898.2, "90th_percentile": 898.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 439.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 439.34, "10th_percentile": 439.34, "90th_percentile": 439.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 732.23, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 732.23, "10th_percentile": 732.23, "90th_percentile": 732.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 761.51, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 761.51, "10th_percentile": 761.51, "90th_percentile": 761.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 634.6, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 634.6, "10th_percentile": 634.6, "90th_percentile": 634.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 490.1, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 490.1, "10th_percentile": 490.1, "90th_percentile": 490.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 518.42, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 518.42, "10th_percentile": 518.42, "90th_percentile": 518.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 514.51, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 514.51, "10th_percentile": 514.51, "90th_percentile": 514.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 738.08, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 738.08, "10th_percentile": 738.08, "90th_percentile": 738.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 545.75, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.75, "10th_percentile": 545.75, "90th_percentile": 545.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 178.66, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 178.66, "10th_percentile": 178.66, "90th_percentile": 178.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 331.94, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 331.94, "10th_percentile": 331.94, "90th_percentile": 331.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 350.49, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 350.49, "10th_percentile": 350.49, "90th_percentile": 350.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 733.2, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 733.2, "10th_percentile": 733.2, "90th_percentile": 733.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 658.03, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 658.03, "10th_percentile": 658.03, "90th_percentile": 658.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 648.17, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 648.17, "10th_percentile": 648.17, "90th_percentile": 648.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 648.17, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 648.17, "10th_percentile": 648.17, "90th_percentile": 648.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 693.17, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 693.17, "10th_percentile": 693.17, "90th_percentile": 693.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 693.17, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 693.17, "10th_percentile": 693.17, "90th_percentile": 693.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 976.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 589.69, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 589.69, "10th_percentile": 589.69, "90th_percentile": 589.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 839.62, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 839.62, "10th_percentile": 839.62, "90th_percentile": 839.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 67.36, "10th_percentile": 67.36, "90th_percentile": 67.36, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 6.9% = $67.36 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $976.30 @ 11.5% = $112.27 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 976.3, "10th_percentile": 976.3, "90th_percentile": 976.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO BLN DIL SCRG PTA OT", "code_information": [ { "code": "SUP-333884", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1371.88, "maximum": 7496.62, "setting": "outpatient", "gross_charge": 7496.62, "discounted_cash": 5247.63, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 4977.01, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 4977.01, "10th_percentile": 4977.01, "90th_percentile": 4977.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 4977.01, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 4977.01, "10th_percentile": 4977.01, "90th_percentile": 4977.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7496.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7496.62, "10th_percentile": 7496.62, "90th_percentile": 7496.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7496.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7496.62, "10th_percentile": 7496.62, "90th_percentile": 7496.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 5322.6, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5322.6, "10th_percentile": 5322.6, "90th_percentile": 5322.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 5322.6, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5322.6, "10th_percentile": 5322.6, "90th_percentile": 5322.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 2691.29, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 2691.29, "10th_percentile": 2691.29, "90th_percentile": 2691.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 2548.85, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 2548.85, "10th_percentile": 2548.85, "90th_percentile": 2548.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 5629.96, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5629.96, "10th_percentile": 5629.96, "90th_percentile": 5629.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1371.88, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1371.88, "10th_percentile": 1371.88, "90th_percentile": 1371.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 5052.72, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5052.72, "10th_percentile": 5052.72, "90th_percentile": 5052.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 5015.24, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5015.24, "10th_percentile": 5015.24, "90th_percentile": 5015.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 3950.72, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3950.72, "10th_percentile": 3950.72, "90th_percentile": 3950.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 4872.8, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 4872.8, "10th_percentile": 4872.8, "90th_percentile": 4872.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 3763.3, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3763.3, "10th_percentile": 3763.3, "90th_percentile": 3763.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 5622.47, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 5622.47, "10th_percentile": 5622.47, "90th_percentile": 5622.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 3980.71, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3980.71, "10th_percentile": 3980.71, "90th_percentile": 3980.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 3373.48, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 3373.48, "10th_percentile": 3373.48, "90th_percentile": 3373.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 6896.89, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 6896.89, "10th_percentile": 6896.89, "90th_percentile": 6896.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 5667.44, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 5667.44, "10th_percentile": 5667.44, "90th_percentile": 5667.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7496.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7496.62, "10th_percentile": 7496.62, "90th_percentile": 7496.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 7496.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 7496.62, "10th_percentile": 7496.62, "90th_percentile": 7496.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 5847.36, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 5847.36, "10th_percentile": 5847.36, "90th_percentile": 5847.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4190.61, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4190.61, "10th_percentile": 4190.61, "90th_percentile": 4190.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 4527.96, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4527.96, "10th_percentile": 4527.96, "90th_percentile": 4527.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 4527.96, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4527.96, "10th_percentile": 4527.96, "90th_percentile": 4527.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4527.96, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4527.96, "10th_percentile": 4527.96, "90th_percentile": 4527.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 6447.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 6447.09, "10th_percentile": 6447.09, "90th_percentile": 6447.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 6447.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 6447.09, "10th_percentile": 6447.09, "90th_percentile": 6447.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 6447.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 6447.09, "10th_percentile": 6447.09, "90th_percentile": 6447.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 6447.09, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 6447.09, "10th_percentile": 6447.09, "90th_percentile": 6447.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 517.27, "10th_percentile": 517.27, "90th_percentile": 517.27, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 517.27, "10th_percentile": 517.27, "90th_percentile": 517.27, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 517.27, "10th_percentile": 517.27, "90th_percentile": 517.27, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 517.27, "10th_percentile": 517.27, "90th_percentile": 517.27, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 517.27, "10th_percentile": 517.27, "90th_percentile": 517.27, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 517.27, "10th_percentile": 517.27, "90th_percentile": 517.27, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 517.27, "10th_percentile": 517.27, "90th_percentile": 517.27, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 6.9% = $517.27 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 11.5% = $862.11 due to $0.00 Claim Price", "median_amount": 862.11, "10th_percentile": 862.11, "90th_percentile": 862.11, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 11.5% = $862.11 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 11.5% = $862.11 due to $0.00 Claim Price", "median_amount": 862.11, "10th_percentile": 862.11, "90th_percentile": 862.11, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,496.62 @ 11.5% = $862.11 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7496.62, "10th_percentile": 7496.62, "90th_percentile": 7496.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG PIG SH NB IMP", "code_information": [ { "code": "SUP-313582", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 15.31, "maximum": 83.68, "setting": "outpatient", "gross_charge": 83.68, "discounted_cash": 58.58, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 71.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 71.96, "10th_percentile": 71.96, "90th_percentile": 71.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 71.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 71.96, "10th_percentile": 71.96, "90th_percentile": 71.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 71.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 71.96, "10th_percentile": 71.96, "90th_percentile": 71.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 71.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 71.96, "10th_percentile": 71.96, "90th_percentile": 71.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 51.47, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.47, "10th_percentile": 51.47, "90th_percentile": 51.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 63.95, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 46.78, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 46.78, "10th_percentile": 46.78, "90th_percentile": 46.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 55.56, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 55.56, "10th_percentile": 55.56, "90th_percentile": 55.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 49.02, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.02, "10th_percentile": 49.02, "90th_percentile": 49.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 49.02, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.02, "10th_percentile": 49.02, "90th_percentile": 49.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 15.31, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 15.31, "10th_percentile": 15.31, "90th_percentile": 15.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 30.04, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 30.04, "10th_percentile": 30.04, "90th_percentile": 30.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 56.4, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 56.4, "10th_percentile": 56.4, "90th_percentile": 56.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 28.45, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 28.45, "10th_percentile": 28.45, "90th_percentile": 28.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 62.84, "10th_percentile": 62.84, "90th_percentile": 62.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 83.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 83.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 83.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 55.98, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 55.98, "10th_percentile": 55.98, "90th_percentile": 55.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 76.99, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 76.99, "10th_percentile": 76.99, "90th_percentile": 76.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 44.1, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.1, "10th_percentile": 44.1, "90th_percentile": 44.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 44.43, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.43, "10th_percentile": 44.43, "90th_percentile": 44.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 65.27, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 65.27, "10th_percentile": 65.27, "90th_percentile": 65.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 37.66, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 37.66, "10th_percentile": 37.66, "90th_percentile": 37.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 55.56, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 55.56, "10th_percentile": 55.56, "90th_percentile": 55.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 62.76, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 62.76, "10th_percentile": 62.76, "90th_percentile": 62.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 63.95, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 54.39, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 54.39, "10th_percentile": 54.39, "90th_percentile": 54.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 42.01, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 42.01, "10th_percentile": 42.01, "90th_percentile": 42.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 63.26, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 63.26, "10th_percentile": 63.26, "90th_percentile": 63.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 83.68, "10th_percentile": 83.68, "90th_percentile": 83.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG 3DRC INFIN 5FRX100CM", "code_information": [ { "code": "SUP-142970", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 17.87, "maximum": 97.63, "setting": "outpatient", "gross_charge": 97.63, "discounted_cash": 68.34, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 60.05, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.05, "10th_percentile": 60.05, "90th_percentile": 60.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 54.58, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.58, "10th_percentile": 54.58, "90th_percentile": 54.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 17.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 17.87, "10th_percentile": 17.87, "90th_percentile": 17.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 35.05, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 35.05, "10th_percentile": 35.05, "90th_percentile": 35.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 65.8, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.8, "10th_percentile": 65.8, "90th_percentile": 65.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 33.19, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 33.19, "10th_percentile": 33.19, "90th_percentile": 33.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 73.32, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.32, "10th_percentile": 73.32, "90th_percentile": 73.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 65.31, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.31, "10th_percentile": 65.31, "90th_percentile": 65.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 89.82, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 89.82, "10th_percentile": 89.82, "90th_percentile": 89.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 51.45, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.45, "10th_percentile": 51.45, "90th_percentile": 51.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 51.84, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.84, "10th_percentile": 51.84, "90th_percentile": 51.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 76.15, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 76.15, "10th_percentile": 76.15, "90th_percentile": 76.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 43.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 43.93, "10th_percentile": 43.93, "90th_percentile": 43.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 73.22, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 73.22, "10th_percentile": 73.22, "90th_percentile": 73.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 63.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 63.46, "10th_percentile": 63.46, "90th_percentile": 63.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 49.01, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.01, "10th_percentile": 49.01, "90th_percentile": 49.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 73.81, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 73.81, "10th_percentile": 73.81, "90th_percentile": 73.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG 6 HOLE STRT PI", "code_information": [ { "code": "SUP-340796", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 8.93, "maximum": 48.82, "setting": "outpatient", "gross_charge": 48.82, "discounted_cash": 34.17, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 30.03, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.03, "10th_percentile": 30.03, "90th_percentile": 30.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37.31, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.31, "10th_percentile": 37.31, "90th_percentile": 37.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 27.29, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.29, "10th_percentile": 27.29, "90th_percentile": 27.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 32.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 32.41, "10th_percentile": 32.41, "90th_percentile": 32.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 28.6, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.6, "10th_percentile": 28.6, "90th_percentile": 28.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 28.6, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.6, "10th_percentile": 28.6, "90th_percentile": 28.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 8.93, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 8.93, "10th_percentile": 8.93, "90th_percentile": 8.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 17.53, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 17.53, "10th_percentile": 17.53, "90th_percentile": 17.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 32.9, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.9, "10th_percentile": 32.9, "90th_percentile": 32.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 16.6, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 16.6, "10th_percentile": 16.6, "90th_percentile": 16.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 36.66, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.66, "10th_percentile": 36.66, "90th_percentile": 36.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 32.66, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.66, "10th_percentile": 32.66, "90th_percentile": 32.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 44.91, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 44.91, "10th_percentile": 44.91, "90th_percentile": 44.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 25.73, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.73, "10th_percentile": 25.73, "90th_percentile": 25.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 25.92, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 38.08, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 38.08, "10th_percentile": 38.08, "90th_percentile": 38.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 21.97, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 21.97, "10th_percentile": 21.97, "90th_percentile": 21.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 32.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 32.41, "10th_percentile": 32.41, "90th_percentile": 32.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 36.62, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 36.62, "10th_percentile": 36.62, "90th_percentile": 36.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37.31, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.31, "10th_percentile": 37.31, "90th_percentile": 37.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 31.73, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 31.73, "10th_percentile": 31.73, "90th_percentile": 31.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 24.51, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.51, "10th_percentile": 24.51, "90th_percentile": 24.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 36.91, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 36.91, "10th_percentile": 36.91, "90th_percentile": 36.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG C1 TORC NB ADV", "code_information": [ { "code": "SUP-112047", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 28.08, "maximum": 153.42, "setting": "outpatient", "gross_charge": 153.42, "discounted_cash": 107.39, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 131.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 131.94, "10th_percentile": 131.94, "90th_percentile": 131.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 131.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 131.94, "10th_percentile": 131.94, "90th_percentile": 131.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 131.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 131.94, "10th_percentile": 131.94, "90th_percentile": 131.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 131.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 131.94, "10th_percentile": 131.94, "90th_percentile": 131.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 94.37, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 94.37, "10th_percentile": 94.37, "90th_percentile": 94.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 117.24, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 117.24, "10th_percentile": 117.24, "90th_percentile": 117.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 85.76, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 85.76, "10th_percentile": 85.76, "90th_percentile": 85.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 153.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 101.86, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 101.86, "10th_percentile": 101.86, "90th_percentile": 101.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 89.87, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 89.87, "10th_percentile": 89.87, "90th_percentile": 89.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 89.87, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 89.87, "10th_percentile": 89.87, "90th_percentile": 89.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 28.08, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 28.08, "10th_percentile": 28.08, "90th_percentile": 28.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 55.08, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 55.08, "10th_percentile": 55.08, "90th_percentile": 55.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 103.41, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 103.41, "10th_percentile": 103.41, "90th_percentile": 103.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 52.16, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 52.16, "10th_percentile": 52.16, "90th_percentile": 52.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 115.22, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 115.22, "10th_percentile": 115.22, "90th_percentile": 115.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 153.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 153.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 153.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 102.64, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 102.64, "10th_percentile": 102.64, "90th_percentile": 102.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 141.15, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 141.15, "10th_percentile": 141.15, "90th_percentile": 141.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 80.85, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 80.85, "10th_percentile": 80.85, "90th_percentile": 80.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 81.47, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 81.47, "10th_percentile": 81.47, "90th_percentile": 81.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 119.67, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 119.67, "10th_percentile": 119.67, "90th_percentile": 119.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 69.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 69.04, "10th_percentile": 69.04, "90th_percentile": 69.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 101.86, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 101.86, "10th_percentile": 101.86, "90th_percentile": 101.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 115.07, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 115.07, "10th_percentile": 115.07, "90th_percentile": 115.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 117.24, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 117.24, "10th_percentile": 117.24, "90th_percentile": 117.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 99.72, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 99.72, "10th_percentile": 99.72, "90th_percentile": 99.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 77.02, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 77.02, "10th_percentile": 77.02, "90th_percentile": 77.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 115.99, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 115.99, "10th_percentile": 115.99, "90th_percentile": 115.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 153.42, "10th_percentile": 153.42, "90th_percentile": 153.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG JL4 INFINITI 5", "code_information": [ { "code": "SUP-316121", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 17.87, "maximum": 97.63, "setting": "outpatient", "gross_charge": 97.63, "discounted_cash": 68.34, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 60.05, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.05, "10th_percentile": 60.05, "90th_percentile": 60.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 54.58, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.58, "10th_percentile": 54.58, "90th_percentile": 54.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 17.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 17.87, "10th_percentile": 17.87, "90th_percentile": 17.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 35.05, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 35.05, "10th_percentile": 35.05, "90th_percentile": 35.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 65.8, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.8, "10th_percentile": 65.8, "90th_percentile": 65.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 33.19, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 33.19, "10th_percentile": 33.19, "90th_percentile": 33.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 73.32, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.32, "10th_percentile": 73.32, "90th_percentile": 73.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 65.31, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.31, "10th_percentile": 65.31, "90th_percentile": 65.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 89.82, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 89.82, "10th_percentile": 89.82, "90th_percentile": 89.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 51.45, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.45, "10th_percentile": 51.45, "90th_percentile": 51.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 51.84, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.84, "10th_percentile": 51.84, "90th_percentile": 51.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 76.15, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 76.15, "10th_percentile": 76.15, "90th_percentile": 76.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 43.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 43.93, "10th_percentile": 43.93, "90th_percentile": 43.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 73.22, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 73.22, "10th_percentile": 73.22, "90th_percentile": 73.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 63.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 63.46, "10th_percentile": 63.46, "90th_percentile": 63.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 49.01, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.01, "10th_percentile": 49.01, "90th_percentile": 49.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 73.81, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 73.81, "10th_percentile": 73.81, "90th_percentile": 73.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG JL4.5 EXPO 6FR", "code_information": [ { "code": "SUP-301641", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 8.93, "maximum": 48.82, "setting": "outpatient", "gross_charge": 48.82, "discounted_cash": 34.17, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 30.03, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.03, "10th_percentile": 30.03, "90th_percentile": 30.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37.31, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.31, "10th_percentile": 37.31, "90th_percentile": 37.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 27.29, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.29, "10th_percentile": 27.29, "90th_percentile": 27.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 32.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 32.41, "10th_percentile": 32.41, "90th_percentile": 32.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 28.6, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.6, "10th_percentile": 28.6, "90th_percentile": 28.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 28.6, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.6, "10th_percentile": 28.6, "90th_percentile": 28.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 8.93, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 8.93, "10th_percentile": 8.93, "90th_percentile": 8.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 17.53, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 17.53, "10th_percentile": 17.53, "90th_percentile": 17.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 32.9, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.9, "10th_percentile": 32.9, "90th_percentile": 32.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 16.6, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 16.6, "10th_percentile": 16.6, "90th_percentile": 16.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 36.66, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.66, "10th_percentile": 36.66, "90th_percentile": 36.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 32.66, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.66, "10th_percentile": 32.66, "90th_percentile": 32.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 44.91, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 44.91, "10th_percentile": 44.91, "90th_percentile": 44.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 25.73, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.73, "10th_percentile": 25.73, "90th_percentile": 25.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 25.92, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 38.08, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 38.08, "10th_percentile": 38.08, "90th_percentile": 38.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 21.97, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 21.97, "10th_percentile": 21.97, "90th_percentile": 21.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 32.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 32.41, "10th_percentile": 32.41, "90th_percentile": 32.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 36.62, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 36.62, "10th_percentile": 36.62, "90th_percentile": 36.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37.31, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.31, "10th_percentile": 37.31, "90th_percentile": 37.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 31.73, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 31.73, "10th_percentile": 31.73, "90th_percentile": 31.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 24.51, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.51, "10th_percentile": 24.51, "90th_percentile": 24.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 36.91, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 36.91, "10th_percentile": 36.91, "90th_percentile": 36.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG JL5 INFIN 6FRX100CM", "code_information": [ { "code": "SUP-365871", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 10.68, "maximum": 58.37, "setting": "outpatient", "gross_charge": 58.37, "discounted_cash": 40.86, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 50.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 50.2, "10th_percentile": 50.2, "90th_percentile": 50.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 50.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 50.2, "10th_percentile": 50.2, "90th_percentile": 50.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 50.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 50.2, "10th_percentile": 50.2, "90th_percentile": 50.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 50.2, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 50.2, "10th_percentile": 50.2, "90th_percentile": 50.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 35.9, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.9, "10th_percentile": 35.9, "90th_percentile": 35.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 44.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 32.63, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.63, "10th_percentile": 32.63, "90th_percentile": 32.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 58.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 38.75, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 38.75, "10th_percentile": 38.75, "90th_percentile": 38.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 34.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.19, "10th_percentile": 34.19, "90th_percentile": 34.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 34.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.19, "10th_percentile": 34.19, "90th_percentile": 34.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 10.68, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 10.68, "10th_percentile": 10.68, "90th_percentile": 10.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 20.95, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 20.95, "10th_percentile": 20.95, "90th_percentile": 20.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 39.34, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.34, "10th_percentile": 39.34, "90th_percentile": 39.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 19.85, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 19.85, "10th_percentile": 19.85, "90th_percentile": 19.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 43.84, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 43.84, "10th_percentile": 43.84, "90th_percentile": 43.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 58.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 58.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 58.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 39.05, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.05, "10th_percentile": 39.05, "90th_percentile": 39.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 53.7, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 53.7, "10th_percentile": 53.7, "90th_percentile": 53.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 30.76, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.76, "10th_percentile": 30.76, "90th_percentile": 30.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 30.99, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.99, "10th_percentile": 30.99, "90th_percentile": 30.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 45.53, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 45.53, "10th_percentile": 45.53, "90th_percentile": 45.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 26.27, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 26.27, "10th_percentile": 26.27, "90th_percentile": 26.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 38.75, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 38.75, "10th_percentile": 38.75, "90th_percentile": 38.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 43.78, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 43.78, "10th_percentile": 43.78, "90th_percentile": 43.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 44.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 37.94, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 37.94, "10th_percentile": 37.94, "90th_percentile": 37.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 29.3, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.3, "10th_percentile": 29.3, "90th_percentile": 29.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 44.13, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 44.13, "10th_percentile": 44.13, "90th_percentile": 44.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 58.37, "10th_percentile": 58.37, "90th_percentile": 58.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG JL6 SUP TORQ + 6FRX100CM", "code_information": [ { "code": "SUP-9023921", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 17.87, "maximum": 97.63, "setting": "outpatient", "gross_charge": 97.63, "discounted_cash": 68.34, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 60.05, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.05, "10th_percentile": 60.05, "90th_percentile": 60.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 54.58, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.58, "10th_percentile": 54.58, "90th_percentile": 54.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 17.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 17.87, "10th_percentile": 17.87, "90th_percentile": 17.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 35.05, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 35.05, "10th_percentile": 35.05, "90th_percentile": 35.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 65.8, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.8, "10th_percentile": 65.8, "90th_percentile": 65.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 33.19, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 33.19, "10th_percentile": 33.19, "90th_percentile": 33.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 73.32, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.32, "10th_percentile": 73.32, "90th_percentile": 73.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 65.31, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.31, "10th_percentile": 65.31, "90th_percentile": 65.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 89.82, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 89.82, "10th_percentile": 89.82, "90th_percentile": 89.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 51.45, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.45, "10th_percentile": 51.45, "90th_percentile": 51.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 51.84, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.84, "10th_percentile": 51.84, "90th_percentile": 51.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 76.15, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 76.15, "10th_percentile": 76.15, "90th_percentile": 76.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 43.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 43.93, "10th_percentile": 43.93, "90th_percentile": 43.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 73.22, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 73.22, "10th_percentile": 73.22, "90th_percentile": 73.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 63.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 63.46, "10th_percentile": 63.46, "90th_percentile": 63.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 49.01, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.01, "10th_percentile": 49.01, "90th_percentile": 49.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 73.81, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 73.81, "10th_percentile": 73.81, "90th_percentile": 73.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG JR4 INFINITI 5", "code_information": [ { "code": "SUP-316120", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 17.87, "maximum": 97.63, "setting": "outpatient", "gross_charge": 97.63, "discounted_cash": 68.34, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 60.05, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.05, "10th_percentile": 60.05, "90th_percentile": 60.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 54.58, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.58, "10th_percentile": 54.58, "90th_percentile": 54.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 17.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 17.87, "10th_percentile": 17.87, "90th_percentile": 17.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 35.05, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 35.05, "10th_percentile": 35.05, "90th_percentile": 35.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 65.8, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.8, "10th_percentile": 65.8, "90th_percentile": 65.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 33.19, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 33.19, "10th_percentile": 33.19, "90th_percentile": 33.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 73.32, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.32, "10th_percentile": 73.32, "90th_percentile": 73.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 65.31, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.31, "10th_percentile": 65.31, "90th_percentile": 65.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 89.82, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 89.82, "10th_percentile": 89.82, "90th_percentile": 89.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 51.45, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.45, "10th_percentile": 51.45, "90th_percentile": 51.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 51.84, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.84, "10th_percentile": 51.84, "90th_percentile": 51.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 76.15, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 76.15, "10th_percentile": 76.15, "90th_percentile": 76.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 43.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 43.93, "10th_percentile": 43.93, "90th_percentile": 43.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 73.22, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 73.22, "10th_percentile": 73.22, "90th_percentile": 73.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 63.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 63.46, "10th_percentile": 63.46, "90th_percentile": 63.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 49.01, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.01, "10th_percentile": 49.01, "90th_percentile": 49.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 73.81, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 73.81, "10th_percentile": 73.81, "90th_percentile": 73.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG JR4 SUP TORQ + 5.2FRX100CM", "code_information": [ { "code": "SUP-104937", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 9.57, "maximum": 52.3, "setting": "outpatient", "gross_charge": 52.3, "discounted_cash": 36.61, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 44.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 44.98, "10th_percentile": 44.98, "90th_percentile": 44.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 44.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 44.98, "10th_percentile": 44.98, "90th_percentile": 44.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 44.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 44.98, "10th_percentile": 44.98, "90th_percentile": 44.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 44.98, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 44.98, "10th_percentile": 44.98, "90th_percentile": 44.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 32.17, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.17, "10th_percentile": 32.17, "90th_percentile": 32.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 39.97, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.97, "10th_percentile": 39.97, "90th_percentile": 39.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 29.24, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.24, "10th_percentile": 29.24, "90th_percentile": 29.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 52.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 34.72, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 34.72, "10th_percentile": 34.72, "90th_percentile": 34.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 30.64, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.64, "10th_percentile": 30.64, "90th_percentile": 30.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 30.64, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.64, "10th_percentile": 30.64, "90th_percentile": 30.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 9.57, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 9.57, "10th_percentile": 9.57, "90th_percentile": 9.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 18.78, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 18.78, "10th_percentile": 18.78, "90th_percentile": 18.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 35.25, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 35.25, "10th_percentile": 35.25, "90th_percentile": 35.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 17.78, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 17.78, "10th_percentile": 17.78, "90th_percentile": 17.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 39.28, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.28, "10th_percentile": 39.28, "90th_percentile": 39.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 52.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 52.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 52.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 34.99, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 34.99, "10th_percentile": 34.99, "90th_percentile": 34.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 48.12, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 48.12, "10th_percentile": 48.12, "90th_percentile": 48.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 27.56, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.56, "10th_percentile": 27.56, "90th_percentile": 27.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 27.77, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.77, "10th_percentile": 27.77, "90th_percentile": 27.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 40.79, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 40.79, "10th_percentile": 40.79, "90th_percentile": 40.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 23.54, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 23.54, "10th_percentile": 23.54, "90th_percentile": 23.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 34.72, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 34.72, "10th_percentile": 34.72, "90th_percentile": 34.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 39.23, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 39.23, "10th_percentile": 39.23, "90th_percentile": 39.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 39.97, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 39.97, "10th_percentile": 39.97, "90th_percentile": 39.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 34.0, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 34.0, "10th_percentile": 34.0, "90th_percentile": 34.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 26.25, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.25, "10th_percentile": 26.25, "90th_percentile": 26.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 39.54, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 39.54, "10th_percentile": 39.54, "90th_percentile": 39.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 52.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG LCB EXPO 6FRX1", "code_information": [ { "code": "SUP-301635", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 8.93, "maximum": 48.82, "setting": "outpatient", "gross_charge": 48.82, "discounted_cash": 34.17, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 30.03, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.03, "10th_percentile": 30.03, "90th_percentile": 30.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37.31, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.31, "10th_percentile": 37.31, "90th_percentile": 37.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 27.29, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.29, "10th_percentile": 27.29, "90th_percentile": 27.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 32.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 32.41, "10th_percentile": 32.41, "90th_percentile": 32.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 28.6, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.6, "10th_percentile": 28.6, "90th_percentile": 28.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 28.6, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.6, "10th_percentile": 28.6, "90th_percentile": 28.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 8.93, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 8.93, "10th_percentile": 8.93, "90th_percentile": 8.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 17.53, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 17.53, "10th_percentile": 17.53, "90th_percentile": 17.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 32.9, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.9, "10th_percentile": 32.9, "90th_percentile": 32.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 16.6, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 16.6, "10th_percentile": 16.6, "90th_percentile": 16.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 36.66, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.66, "10th_percentile": 36.66, "90th_percentile": 36.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 32.66, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.66, "10th_percentile": 32.66, "90th_percentile": 32.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 44.91, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 44.91, "10th_percentile": 44.91, "90th_percentile": 44.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 25.73, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.73, "10th_percentile": 25.73, "90th_percentile": 25.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 25.92, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 38.08, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 38.08, "10th_percentile": 38.08, "90th_percentile": 38.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 21.97, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 21.97, "10th_percentile": 21.97, "90th_percentile": 21.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 32.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 32.41, "10th_percentile": 32.41, "90th_percentile": 32.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 36.62, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 36.62, "10th_percentile": 36.62, "90th_percentile": 36.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37.31, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.31, "10th_percentile": 37.31, "90th_percentile": 37.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 31.73, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 31.73, "10th_percentile": 31.73, "90th_percentile": 31.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 24.51, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.51, "10th_percentile": 24.51, "90th_percentile": 24.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 36.91, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 36.91, "10th_percentile": 36.91, "90th_percentile": 36.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG LCB INFINITI 4FRX100CM", "code_information": [ { "code": "SUP-357602", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 9.19, "maximum": 50.21, "setting": "outpatient", "gross_charge": 50.21, "discounted_cash": 35.15, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 43.18, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 43.18, "10th_percentile": 43.18, "90th_percentile": 43.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 43.18, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 43.18, "10th_percentile": 43.18, "90th_percentile": 43.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 43.18, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 43.18, "10th_percentile": 43.18, "90th_percentile": 43.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 43.18, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 43.18, "10th_percentile": 43.18, "90th_percentile": 43.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 30.88, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.88, "10th_percentile": 30.88, "90th_percentile": 30.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 38.37, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38.37, "10th_percentile": 38.37, "90th_percentile": 38.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 28.07, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.07, "10th_percentile": 28.07, "90th_percentile": 28.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 50.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 33.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 33.33, "10th_percentile": 33.33, "90th_percentile": 33.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 29.41, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.41, "10th_percentile": 29.41, "90th_percentile": 29.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 29.41, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.41, "10th_percentile": 29.41, "90th_percentile": 29.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 9.19, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 9.19, "10th_percentile": 9.19, "90th_percentile": 9.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 18.03, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 18.03, "10th_percentile": 18.03, "90th_percentile": 18.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 33.84, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.84, "10th_percentile": 33.84, "90th_percentile": 33.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 17.07, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 17.07, "10th_percentile": 17.07, "90th_percentile": 17.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 37.71, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.71, "10th_percentile": 37.71, "90th_percentile": 37.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 50.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 50.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 50.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 33.59, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 33.59, "10th_percentile": 33.59, "90th_percentile": 33.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 46.19, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 46.19, "10th_percentile": 46.19, "90th_percentile": 46.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 26.46, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.46, "10th_percentile": 26.46, "90th_percentile": 26.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 26.66, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 26.66, "10th_percentile": 26.66, "90th_percentile": 26.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 39.16, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 39.16, "10th_percentile": 39.16, "90th_percentile": 39.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 22.59, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 22.59, "10th_percentile": 22.59, "90th_percentile": 22.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 33.33, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 33.33, "10th_percentile": 33.33, "90th_percentile": 33.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 37.66, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 37.66, "10th_percentile": 37.66, "90th_percentile": 37.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 38.37, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 38.37, "10th_percentile": 38.37, "90th_percentile": 38.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 32.64, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 25.21, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.21, "10th_percentile": 25.21, "90th_percentile": 25.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 37.96, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 37.96, "10th_percentile": 37.96, "90th_percentile": 37.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 50.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG PIG INFIN 5FRX", "code_information": [ { "code": "SUP-151383", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 17.87, "maximum": 97.63, "setting": "outpatient", "gross_charge": 97.63, "discounted_cash": 68.34, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 83.96, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 83.96, "10th_percentile": 83.96, "90th_percentile": 83.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 60.05, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.05, "10th_percentile": 60.05, "90th_percentile": 60.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 54.58, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.58, "10th_percentile": 54.58, "90th_percentile": 54.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 57.19, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 57.19, "10th_percentile": 57.19, "90th_percentile": 57.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 17.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 17.87, "10th_percentile": 17.87, "90th_percentile": 17.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 35.05, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 35.05, "10th_percentile": 35.05, "90th_percentile": 35.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 65.8, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.8, "10th_percentile": 65.8, "90th_percentile": 65.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 33.19, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 33.19, "10th_percentile": 33.19, "90th_percentile": 33.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 73.32, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 73.32, "10th_percentile": 73.32, "90th_percentile": 73.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 97.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 65.31, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 65.31, "10th_percentile": 65.31, "90th_percentile": 65.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 89.82, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 89.82, "10th_percentile": 89.82, "90th_percentile": 89.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 51.45, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.45, "10th_percentile": 51.45, "90th_percentile": 51.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 51.84, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 51.84, "10th_percentile": 51.84, "90th_percentile": 51.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 76.15, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 76.15, "10th_percentile": 76.15, "90th_percentile": 76.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 43.93, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 43.93, "10th_percentile": 43.93, "90th_percentile": 43.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 64.82, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 64.82, "10th_percentile": 64.82, "90th_percentile": 64.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 73.22, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 73.22, "10th_percentile": 73.22, "90th_percentile": 73.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 74.61, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 74.61, "10th_percentile": 74.61, "90th_percentile": 74.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 63.46, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 63.46, "10th_percentile": 63.46, "90th_percentile": 63.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 49.01, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 49.01, "10th_percentile": 49.01, "90th_percentile": 49.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 73.81, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 73.81, "10th_percentile": 73.81, "90th_percentile": 73.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.63, "10th_percentile": 97.63, "90th_percentile": 97.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG RCB EXPO SNGL", "code_information": [ { "code": "SUP-340799", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 8.93, "maximum": 48.82, "setting": "outpatient", "gross_charge": 48.82, "discounted_cash": 34.17, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 41.99, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 41.99, "10th_percentile": 41.99, "90th_percentile": 41.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 30.03, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30.03, "10th_percentile": 30.03, "90th_percentile": 30.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37.31, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.31, "10th_percentile": 37.31, "90th_percentile": 37.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 27.29, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 27.29, "10th_percentile": 27.29, "90th_percentile": 27.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 32.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 32.41, "10th_percentile": 32.41, "90th_percentile": 32.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 28.6, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.6, "10th_percentile": 28.6, "90th_percentile": 28.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 28.6, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.6, "10th_percentile": 28.6, "90th_percentile": 28.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 8.93, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 8.93, "10th_percentile": 8.93, "90th_percentile": 8.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 17.53, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 17.53, "10th_percentile": 17.53, "90th_percentile": 17.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 32.9, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.9, "10th_percentile": 32.9, "90th_percentile": 32.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 16.6, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 16.6, "10th_percentile": 16.6, "90th_percentile": 16.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 36.66, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 36.66, "10th_percentile": 36.66, "90th_percentile": 36.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 48.82, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 32.66, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 32.66, "10th_percentile": 32.66, "90th_percentile": 32.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 44.91, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 44.91, "10th_percentile": 44.91, "90th_percentile": 44.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 25.73, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.73, "10th_percentile": 25.73, "90th_percentile": 25.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 25.92, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 38.08, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 38.08, "10th_percentile": 38.08, "90th_percentile": 38.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 21.97, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 21.97, "10th_percentile": 21.97, "90th_percentile": 21.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 32.41, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 32.41, "10th_percentile": 32.41, "90th_percentile": 32.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 36.62, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 36.62, "10th_percentile": 36.62, "90th_percentile": 36.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 37.31, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 37.31, "10th_percentile": 37.31, "90th_percentile": 37.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 31.73, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 31.73, "10th_percentile": 31.73, "90th_percentile": 31.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 24.51, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24.51, "10th_percentile": 24.51, "90th_percentile": 24.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 36.91, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 36.91, "10th_percentile": 36.91, "90th_percentile": 36.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48.82, "10th_percentile": 48.82, "90th_percentile": 48.82, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG RF HF PIG 5FR", "code_information": [ { "code": "SUP-339790", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 16.59, "maximum": 90.66, "setting": "outpatient", "gross_charge": 90.66, "discounted_cash": 63.46, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 77.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 77.97, "10th_percentile": 77.97, "90th_percentile": 77.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 77.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 77.97, "10th_percentile": 77.97, "90th_percentile": 77.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 77.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 77.97, "10th_percentile": 77.97, "90th_percentile": 77.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 77.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 77.97, "10th_percentile": 77.97, "90th_percentile": 77.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 55.76, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 55.76, "10th_percentile": 55.76, "90th_percentile": 55.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 69.28, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 69.28, "10th_percentile": 69.28, "90th_percentile": 69.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 50.68, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.68, "10th_percentile": 50.68, "90th_percentile": 50.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 90.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 60.19, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 60.19, "10th_percentile": 60.19, "90th_percentile": 60.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 53.11, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.11, "10th_percentile": 53.11, "90th_percentile": 53.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 53.11, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.11, "10th_percentile": 53.11, "90th_percentile": 53.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 16.59, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 16.59, "10th_percentile": 16.59, "90th_percentile": 16.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 32.55, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 32.55, "10th_percentile": 32.55, "90th_percentile": 32.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 61.1, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.1, "10th_percentile": 61.1, "90th_percentile": 61.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 30.82, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 30.82, "10th_percentile": 30.82, "90th_percentile": 30.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 68.09, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.09, "10th_percentile": 68.09, "90th_percentile": 68.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 90.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 90.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 90.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 60.65, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.65, "10th_percentile": 60.65, "90th_percentile": 60.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 83.41, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 83.41, "10th_percentile": 83.41, "90th_percentile": 83.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 47.78, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 47.78, "10th_percentile": 47.78, "90th_percentile": 47.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 48.14, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.14, "10th_percentile": 48.14, "90th_percentile": 48.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 70.71, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 70.71, "10th_percentile": 70.71, "90th_percentile": 70.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 40.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 40.8, "10th_percentile": 40.8, "90th_percentile": 40.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 60.19, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 60.19, "10th_percentile": 60.19, "90th_percentile": 60.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 68.0, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 68.0, "10th_percentile": 68.0, "90th_percentile": 68.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 69.28, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 69.28, "10th_percentile": 69.28, "90th_percentile": 69.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 58.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 58.93, "10th_percentile": 58.93, "90th_percentile": 58.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 45.51, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.51, "10th_percentile": 45.51, "90th_percentile": 45.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 68.54, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 68.54, "10th_percentile": 68.54, "90th_percentile": 68.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG SH TEMPO 4FRX6", "code_information": [ { "code": "SUP-303996", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 19.08, "maximum": 104.26, "setting": "outpatient", "gross_charge": 104.26, "discounted_cash": 72.98, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 89.66, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 89.66, "10th_percentile": 89.66, "90th_percentile": 89.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 89.66, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 89.66, "10th_percentile": 89.66, "90th_percentile": 89.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 89.66, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 89.66, "10th_percentile": 89.66, "90th_percentile": 89.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 89.66, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 89.66, "10th_percentile": 89.66, "90th_percentile": 89.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 64.13, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 64.13, "10th_percentile": 64.13, "90th_percentile": 64.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 79.68, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 79.68, "10th_percentile": 79.68, "90th_percentile": 79.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 58.28, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 58.28, "10th_percentile": 58.28, "90th_percentile": 58.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 69.22, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 69.22, "10th_percentile": 69.22, "90th_percentile": 69.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 61.08, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.08, "10th_percentile": 61.08, "90th_percentile": 61.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 61.08, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.08, "10th_percentile": 61.08, "90th_percentile": 61.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 19.08, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 19.08, "10th_percentile": 19.08, "90th_percentile": 19.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 37.43, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 37.43, "10th_percentile": 37.43, "90th_percentile": 37.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 70.27, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 70.27, "10th_percentile": 70.27, "90th_percentile": 70.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 35.45, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 35.45, "10th_percentile": 35.45, "90th_percentile": 35.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 78.3, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 78.3, "10th_percentile": 78.3, "90th_percentile": 78.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 104.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 104.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 104.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 69.75, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 69.75, "10th_percentile": 69.75, "90th_percentile": 69.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 95.92, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 95.92, "10th_percentile": 95.92, "90th_percentile": 95.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 54.95, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 54.95, "10th_percentile": 54.95, "90th_percentile": 54.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 55.36, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 55.36, "10th_percentile": 55.36, "90th_percentile": 55.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 81.32, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 81.32, "10th_percentile": 81.32, "90th_percentile": 81.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 46.92, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 46.92, "10th_percentile": 46.92, "90th_percentile": 46.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 69.22, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 69.22, "10th_percentile": 69.22, "90th_percentile": 69.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 78.2, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 78.2, "10th_percentile": 78.2, "90th_percentile": 78.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 79.68, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 79.68, "10th_percentile": 79.68, "90th_percentile": 79.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 67.77, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 67.77, "10th_percentile": 67.77, "90th_percentile": 67.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 52.34, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 52.34, "10th_percentile": 52.34, "90th_percentile": 52.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 78.82, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 78.82, "10th_percentile": 78.82, "90th_percentile": 78.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG SIM2 NON-BEAC", "code_information": [ { "code": "SUP-314878", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 16.59, "maximum": 90.66, "setting": "outpatient", "gross_charge": 90.66, "discounted_cash": 63.46, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 77.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 77.97, "10th_percentile": 77.97, "90th_percentile": 77.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 77.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 77.97, "10th_percentile": 77.97, "90th_percentile": 77.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 77.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 77.97, "10th_percentile": 77.97, "90th_percentile": 77.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 77.97, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 77.97, "10th_percentile": 77.97, "90th_percentile": 77.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 55.76, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 55.76, "10th_percentile": 55.76, "90th_percentile": 55.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 69.28, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 69.28, "10th_percentile": 69.28, "90th_percentile": 69.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 50.68, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 50.68, "10th_percentile": 50.68, "90th_percentile": 50.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 90.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 60.19, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 60.19, "10th_percentile": 60.19, "90th_percentile": 60.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 53.11, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.11, "10th_percentile": 53.11, "90th_percentile": 53.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 53.11, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 53.11, "10th_percentile": 53.11, "90th_percentile": 53.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 16.59, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 16.59, "10th_percentile": 16.59, "90th_percentile": 16.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 32.55, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 32.55, "10th_percentile": 32.55, "90th_percentile": 32.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 61.1, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 61.1, "10th_percentile": 61.1, "90th_percentile": 61.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 30.82, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 30.82, "10th_percentile": 30.82, "90th_percentile": 30.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 68.09, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.09, "10th_percentile": 68.09, "90th_percentile": 68.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 90.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 90.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 90.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 60.65, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 60.65, "10th_percentile": 60.65, "90th_percentile": 60.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 83.41, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 83.41, "10th_percentile": 83.41, "90th_percentile": 83.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 47.78, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 47.78, "10th_percentile": 47.78, "90th_percentile": 47.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 48.14, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 48.14, "10th_percentile": 48.14, "90th_percentile": 48.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 70.71, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 70.71, "10th_percentile": 70.71, "90th_percentile": 70.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 40.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 40.8, "10th_percentile": 40.8, "90th_percentile": 40.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 60.19, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 60.19, "10th_percentile": 60.19, "90th_percentile": 60.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 68.0, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 68.0, "10th_percentile": 68.0, "90th_percentile": 68.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 69.28, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 69.28, "10th_percentile": 69.28, "90th_percentile": 69.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 58.93, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 58.93, "10th_percentile": 58.93, "90th_percentile": 58.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 45.51, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.51, "10th_percentile": 45.51, "90th_percentile": 45.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 68.54, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 68.54, "10th_percentile": 68.54, "90th_percentile": 68.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 90.66, "10th_percentile": 90.66, "90th_percentile": 90.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO DIAG SZG MOD HK SH 5FRX100CM", "code_information": [ { "code": "SUP-313523", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 121.24, "maximum": 662.49, "setting": "outpatient", "gross_charge": 662.49, "discounted_cash": 463.74, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 407.5, "standard_charge_percentage": 61.51, "standard_charge_algorithm": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 407.5, "10th_percentile": 407.5, "90th_percentile": 407.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 61.51% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 506.27, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 506.27, "10th_percentile": 506.27, "90th_percentile": 506.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 370.33, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 370.33, "10th_percentile": 370.33, "90th_percentile": 370.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 439.83, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 439.83, "10th_percentile": 439.83, "90th_percentile": 439.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 388.09, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 388.09, "10th_percentile": 388.09, "90th_percentile": 388.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 388.09, "standard_charge_percentage": 58.58, "standard_charge_algorithm": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 388.09, "10th_percentile": 388.09, "90th_percentile": 388.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 58.58% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 121.24, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 121.24, "10th_percentile": 121.24, "90th_percentile": 121.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 237.83, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 237.83, "10th_percentile": 237.83, "90th_percentile": 237.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 446.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 446.52, "10th_percentile": 446.52, "90th_percentile": 446.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 225.25, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 225.25, "10th_percentile": 225.25, "90th_percentile": 225.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 497.53, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 497.53, "10th_percentile": 497.53, "90th_percentile": 497.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 443.21, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 443.21, "10th_percentile": 443.21, "90th_percentile": 443.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 609.49, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 609.49, "10th_percentile": 609.49, "90th_percentile": 609.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 349.13, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 349.13, "10th_percentile": 349.13, "90th_percentile": 349.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 351.78, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 351.78, "10th_percentile": 351.78, "90th_percentile": 351.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 516.74, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 516.74, "10th_percentile": 516.74, "90th_percentile": 516.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 298.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 298.12, "10th_percentile": 298.12, "90th_percentile": 298.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 439.83, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 439.83, "10th_percentile": 439.83, "90th_percentile": 439.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 496.87, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 496.87, "10th_percentile": 496.87, "90th_percentile": 496.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 506.27, "standard_charge_percentage": 76.42, "standard_charge_algorithm": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 506.27, "10th_percentile": 506.27, "90th_percentile": 506.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 76.42% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 430.62, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 430.62, "10th_percentile": 430.62, "90th_percentile": 430.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 332.57, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 332.57, "10th_percentile": 332.57, "90th_percentile": 332.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 500.84, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 500.84, "10th_percentile": 500.84, "90th_percentile": 500.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID ADV CRNRY SINU", "code_information": [ { "code": "SUP-317018", "type": "CDM" }, { "code": "C1892", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 497.71, "maximum": 2719.7, "setting": "outpatient", "gross_charge": 2719.7, "discounted_cash": 1903.79, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2719.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2719.7, "10th_percentile": 2719.7, "90th_percentile": 2719.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2719.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2719.7, "10th_percentile": 2719.7, "90th_percentile": 2719.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1930.99, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1930.99, "10th_percentile": 1930.99, "90th_percentile": 1930.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1930.99, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1930.99, "10th_percentile": 1930.99, "90th_percentile": 1930.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 497.71, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 497.71, "10th_percentile": 497.71, "90th_percentile": 497.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 924.7, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 924.7, "10th_percentile": 924.7, "90th_percentile": 924.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 976.37, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 976.37, "10th_percentile": 976.37, "90th_percentile": 976.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 2042.49, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2042.49, "10th_percentile": 2042.49, "90th_percentile": 2042.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1833.08, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1833.08, "10th_percentile": 1833.08, "90th_percentile": 1833.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1767.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1767.81, "10th_percentile": 1767.81, "90th_percentile": 1767.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 1223.87, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 1223.87, "10th_percentile": 1223.87, "90th_percentile": 1223.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2719.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2719.7, "10th_percentile": 2719.7, "90th_percentile": 2719.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 2502.12, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 2502.12, "10th_percentile": 2502.12, "90th_percentile": 2502.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1444.16, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1444.16, "10th_percentile": 1444.16, "90th_percentile": 1444.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1365.29, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1365.29, "10th_percentile": 1365.29, "90th_percentile": 1365.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1819.48, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1819.48, "10th_percentile": 1819.48, "90th_percentile": 1819.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2719.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2719.7, "10th_percentile": 2719.7, "90th_percentile": 2719.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1520.31, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1520.31, "10th_percentile": 1520.31, "90th_percentile": 1520.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 2039.78, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 2039.78, "10th_percentile": 2039.78, "90th_percentile": 2039.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 2056.09, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 2056.09, "10th_percentile": 2056.09, "90th_percentile": 2056.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 2121.37, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 2121.37, "10th_percentile": 2121.37, "90th_percentile": 2121.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1433.28, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1433.28, "10th_percentile": 1433.28, "90th_percentile": 1433.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1805.61, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1805.61, "10th_percentile": 1805.61, "90th_percentile": 1805.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1805.61, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1805.61, "10th_percentile": 1805.61, "90th_percentile": 1805.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1642.7, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1642.7, "10th_percentile": 1642.7, "90th_percentile": 1642.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1642.7, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1642.7, "10th_percentile": 1642.7, "90th_percentile": 1642.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1642.7, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1642.7, "10th_percentile": 1642.7, "90th_percentile": 1642.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2338.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2338.94, "10th_percentile": 2338.94, "90th_percentile": 2338.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2338.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2338.94, "10th_percentile": 2338.94, "90th_percentile": 2338.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2338.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2338.94, "10th_percentile": 2338.94, "90th_percentile": 2338.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 2338.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 2338.94, "10th_percentile": 2338.94, "90th_percentile": 2338.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.66, "10th_percentile": 187.66, "90th_percentile": 187.66, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.66, "10th_percentile": 187.66, "90th_percentile": 187.66, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.66, "10th_percentile": 187.66, "90th_percentile": 187.66, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.66, "10th_percentile": 187.66, "90th_percentile": 187.66, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.66, "10th_percentile": 187.66, "90th_percentile": 187.66, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.66, "10th_percentile": 187.66, "90th_percentile": 187.66, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 187.66, "10th_percentile": 187.66, "90th_percentile": 187.66, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 6.9% = $187.66 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 11.5% = $312.77 due to $0.00 Claim Price", "median_amount": 312.77, "10th_percentile": 312.77, "90th_percentile": 312.77, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 11.5% = $312.77 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 11.5% = $312.77 due to $0.00 Claim Price", "median_amount": 312.77, "10th_percentile": 312.77, "90th_percentile": 312.77, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,719.70 @ 11.5% = $312.77 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2719.7, "10th_percentile": 2719.7, "90th_percentile": 2719.7, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID C1 GLDECATH 5F", "code_information": [ { "code": "SUP-9004153", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 67.87, "maximum": 370.86, "setting": "outpatient", "gross_charge": 370.86, "discounted_cash": 259.6, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 318.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 318.94, "10th_percentile": 318.94, "90th_percentile": 318.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 318.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 318.94, "10th_percentile": 318.94, "90th_percentile": 318.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 318.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 318.94, "10th_percentile": 318.94, "90th_percentile": 318.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 318.94, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 318.94, "10th_percentile": 318.94, "90th_percentile": 318.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 224.0, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.0, "10th_percentile": 224.0, "90th_percentile": 224.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 224.0, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.0, "10th_percentile": 224.0, "90th_percentile": 224.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 224.0, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 224.0, "10th_percentile": 224.0, "90th_percentile": 224.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 246.21, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 246.21, "10th_percentile": 246.21, "90th_percentile": 246.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 246.21, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 246.21, "10th_percentile": 246.21, "90th_percentile": 246.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 370.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 370.86, "10th_percentile": 370.86, "90th_percentile": 370.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 370.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 370.86, "10th_percentile": 370.86, "90th_percentile": 370.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 263.31, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 263.31, "10th_percentile": 263.31, "90th_percentile": 263.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 263.31, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 263.31, "10th_percentile": 263.31, "90th_percentile": 263.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 67.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 67.87, "10th_percentile": 67.87, "90th_percentile": 67.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 133.14, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 133.14, "10th_percentile": 133.14, "90th_percentile": 133.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 249.96, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 249.96, "10th_percentile": 249.96, "90th_percentile": 249.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 278.52, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 278.52, "10th_percentile": 278.52, "90th_percentile": 278.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 126.09, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 126.09, "10th_percentile": 126.09, "90th_percentile": 126.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 195.44, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 370.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 370.86, "10th_percentile": 370.86, "90th_percentile": 370.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 289.27, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 289.27, "10th_percentile": 289.27, "90th_percentile": 289.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 186.17, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 186.17, "10th_percentile": 186.17, "90th_percentile": 186.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 280.37, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 280.37, "10th_percentile": 280.37, "90th_percentile": 280.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 166.89, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 166.89, "10th_percentile": 166.89, "90th_percentile": 166.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 207.31, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 207.31, "10th_percentile": 207.31, "90th_percentile": 207.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 370.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 370.86, "10th_percentile": 370.86, "90th_percentile": 370.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 341.19, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 341.19, "10th_percentile": 341.19, "90th_percentile": 341.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 241.06, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 241.06, "10th_percentile": 241.06, "90th_percentile": 241.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 196.93, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 196.93, "10th_percentile": 196.93, "90th_percentile": 196.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 278.15, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 278.15, "10th_percentile": 278.15, "90th_percentile": 278.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 248.11, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 248.11, "10th_percentile": 248.11, "90th_percentile": 248.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.59, "10th_percentile": 25.59, "90th_percentile": 25.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.59, "10th_percentile": 25.59, "90th_percentile": 25.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.59, "10th_percentile": 25.59, "90th_percentile": 25.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.59, "10th_percentile": 25.59, "90th_percentile": 25.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.59, "10th_percentile": 25.59, "90th_percentile": 25.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.59, "10th_percentile": 25.59, "90th_percentile": 25.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25.59, "10th_percentile": 25.59, "90th_percentile": 25.59, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 6.9% = $25.59 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 11.5% = $42.65 due to $0.00 Claim Price", "median_amount": 42.65, "10th_percentile": 42.65, "90th_percentile": 42.65, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 11.5% = $42.65 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 11.5% = $42.65 due to $0.00 Claim Price", "median_amount": 42.65, "10th_percentile": 42.65, "90th_percentile": 42.65, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $370.86 @ 11.5% = $42.65 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 370.86, "10th_percentile": 370.86, "90th_percentile": 370.86, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID IL4 HEARTRAIL", "code_information": [ { "code": "SUP-147954", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 121.24, "maximum": 662.49, "setting": "outpatient", "gross_charge": 662.49, "discounted_cash": 463.74, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 400.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 400.14, "10th_percentile": 400.14, "90th_percentile": 400.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 400.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 400.14, "10th_percentile": 400.14, "90th_percentile": 400.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 400.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 400.14, "10th_percentile": 400.14, "90th_percentile": 400.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 439.83, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 439.83, "10th_percentile": 439.83, "90th_percentile": 439.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 439.83, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 439.83, "10th_percentile": 439.83, "90th_percentile": 439.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 470.37, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 470.37, "10th_percentile": 470.37, "90th_percentile": 470.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 470.37, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 470.37, "10th_percentile": 470.37, "90th_percentile": 470.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 121.24, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 121.24, "10th_percentile": 121.24, "90th_percentile": 121.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 237.83, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 237.83, "10th_percentile": 237.83, "90th_percentile": 237.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 446.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 446.52, "10th_percentile": 446.52, "90th_percentile": 446.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 497.53, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 497.53, "10th_percentile": 497.53, "90th_percentile": 497.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 225.25, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 225.25, "10th_percentile": 225.25, "90th_percentile": 225.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 349.13, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 516.74, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 516.74, "10th_percentile": 516.74, "90th_percentile": 516.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 332.57, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 332.57, "10th_percentile": 332.57, "90th_percentile": 332.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 500.84, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 500.84, "10th_percentile": 500.84, "90th_percentile": 500.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 298.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 298.12, "10th_percentile": 298.12, "90th_percentile": 298.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 370.33, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 370.33, "10th_percentile": 370.33, "90th_percentile": 370.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 609.49, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 609.49, "10th_percentile": 609.49, "90th_percentile": 609.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 430.62, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 430.62, "10th_percentile": 430.62, "90th_percentile": 430.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 351.78, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 351.78, "10th_percentile": 351.78, "90th_percentile": 351.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 496.87, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 496.87, "10th_percentile": 496.87, "90th_percentile": 496.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 443.21, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 443.21, "10th_percentile": 443.21, "90th_percentile": 443.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 11.5% = $76.19 due to $0.00 Claim Price", "median_amount": 76.19, "10th_percentile": 76.19, "90th_percentile": 76.19, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 11.5% = $76.19 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 11.5% = $76.19 due to $0.00 Claim Price", "median_amount": 76.19, "10th_percentile": 76.19, "90th_percentile": 76.19, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 11.5% = $76.19 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID JL3.5 HEARTRAIL III 6FRX100CM", "code_information": [ { "code": "SUP-147952", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 121.24, "maximum": 662.49, "setting": "outpatient", "gross_charge": 662.49, "discounted_cash": 463.74, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 569.74, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 569.74, "10th_percentile": 569.74, "90th_percentile": 569.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 400.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 400.14, "10th_percentile": 400.14, "90th_percentile": 400.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 400.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 400.14, "10th_percentile": 400.14, "90th_percentile": 400.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 400.14, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 400.14, "10th_percentile": 400.14, "90th_percentile": 400.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 439.83, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 439.83, "10th_percentile": 439.83, "90th_percentile": 439.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 439.83, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 439.83, "10th_percentile": 439.83, "90th_percentile": 439.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 470.37, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 470.37, "10th_percentile": 470.37, "90th_percentile": 470.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 470.37, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 470.37, "10th_percentile": 470.37, "90th_percentile": 470.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 121.24, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 121.24, "10th_percentile": 121.24, "90th_percentile": 121.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 237.83, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 237.83, "10th_percentile": 237.83, "90th_percentile": 237.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 446.52, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 446.52, "10th_percentile": 446.52, "90th_percentile": 446.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 497.53, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 497.53, "10th_percentile": 497.53, "90th_percentile": 497.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 225.25, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 225.25, "10th_percentile": 225.25, "90th_percentile": 225.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 349.13, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 516.74, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 516.74, "10th_percentile": 516.74, "90th_percentile": 516.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 332.57, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 332.57, "10th_percentile": 332.57, "90th_percentile": 332.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 500.84, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 500.84, "10th_percentile": 500.84, "90th_percentile": 500.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 298.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 298.12, "10th_percentile": 298.12, "90th_percentile": 298.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 370.33, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 370.33, "10th_percentile": 370.33, "90th_percentile": 370.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 662.49, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 609.49, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 609.49, "10th_percentile": 609.49, "90th_percentile": 609.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 430.62, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 430.62, "10th_percentile": 430.62, "90th_percentile": 430.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 351.78, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 351.78, "10th_percentile": 351.78, "90th_percentile": 351.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 496.87, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 496.87, "10th_percentile": 496.87, "90th_percentile": 496.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 443.21, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 443.21, "10th_percentile": 443.21, "90th_percentile": 443.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 45.71, "10th_percentile": 45.71, "90th_percentile": 45.71, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 6.9% = $45.71 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 11.5% = $76.19 due to $0.00 Claim Price", "median_amount": 76.19, "10th_percentile": 76.19, "90th_percentile": 76.19, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 11.5% = $76.19 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 11.5% = $76.19 due to $0.00 Claim Price", "median_amount": 76.19, "10th_percentile": 76.19, "90th_percentile": 76.19, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $662.49 @ 11.5% = $76.19 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 662.49, "10th_percentile": 662.49, "90th_percentile": 662.49, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID JL4 VSTA BRT T", "code_information": [ { "code": "SUP-9044174", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 54.87, "maximum": 299.86, "setting": "outpatient", "gross_charge": 299.86, "discounted_cash": 209.9, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 224.9, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 224.9, "10th_percentile": 224.9, "90th_percentile": 224.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 134.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 134.94, "10th_percentile": 134.94, "90th_percentile": 134.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 233.89, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 233.89, "10th_percentile": 233.89, "90th_percentile": 233.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 200.61, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 200.61, "10th_percentile": 200.61, "90th_percentile": 200.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 275.87, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 275.87, "10th_percentile": 275.87, "90th_percentile": 275.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 194.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 194.91, "10th_percentile": 194.91, "90th_percentile": 194.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 150.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 150.53, "10th_percentile": 150.53, "90th_percentile": 150.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 159.23, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 159.23, "10th_percentile": 159.23, "90th_percentile": 159.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 226.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 226.69, "10th_percentile": 226.69, "90th_percentile": 226.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 158.03, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 167.62, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 167.62, "10th_percentile": 167.62, "90th_percentile": 167.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 107.65, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 107.65, "10th_percentile": 107.65, "90th_percentile": 107.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 101.95, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 101.95, "10th_percentile": 101.95, "90th_percentile": 101.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 225.19, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 225.19, "10th_percentile": 225.19, "90th_percentile": 225.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 54.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 54.87, "10th_percentile": 54.87, "90th_percentile": 54.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 202.11, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 202.11, "10th_percentile": 202.11, "90th_percentile": 202.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID JR3 LAUNCHER 6", "code_information": [ { "code": "SUP-104189", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 57.43, "maximum": 313.81, "setting": "outpatient", "gross_charge": 313.81, "discounted_cash": 219.67, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 165.38, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 166.63, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 166.63, "10th_percentile": 166.63, "90th_percentile": 166.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 237.24, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 237.24, "10th_percentile": 237.24, "90th_percentile": 237.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 235.36, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 235.36, "10th_percentile": 235.36, "90th_percentile": 235.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 175.42, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 175.42, "10th_percentile": 175.42, "90th_percentile": 175.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 209.94, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 209.94, "10th_percentile": 209.94, "90th_percentile": 209.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 157.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 157.53, "10th_percentile": 157.53, "90th_percentile": 157.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 244.77, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 244.77, "10th_percentile": 244.77, "90th_percentile": 244.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 141.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 141.21, "10th_percentile": 141.21, "90th_percentile": 141.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 288.71, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 288.71, "10th_percentile": 288.71, "90th_percentile": 288.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 203.98, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 203.98, "10th_percentile": 203.98, "90th_percentile": 203.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 211.51, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 211.51, "10th_percentile": 211.51, "90th_percentile": 211.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 235.67, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 235.67, "10th_percentile": 235.67, "90th_percentile": 235.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 112.66, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 112.66, "10th_percentile": 112.66, "90th_percentile": 112.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 106.7, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 106.7, "10th_percentile": 106.7, "90th_percentile": 106.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 57.43, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 57.43, "10th_percentile": 57.43, "90th_percentile": 57.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 208.34, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 208.34, "10th_percentile": 208.34, "90th_percentile": 208.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 208.34, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 208.34, "10th_percentile": 208.34, "90th_percentile": 208.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 222.81, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 222.81, "10th_percentile": 222.81, "90th_percentile": 222.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 222.81, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 222.81, "10th_percentile": 222.81, "90th_percentile": 222.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 189.54, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.54, "10th_percentile": 189.54, "90th_percentile": 189.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 189.54, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.54, "10th_percentile": 189.54, "90th_percentile": 189.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 189.54, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.54, "10th_percentile": 189.54, "90th_percentile": 189.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price", "median_amount": 36.09, "10th_percentile": 36.09, "90th_percentile": 36.09, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price", "median_amount": 36.09, "10th_percentile": 36.09, "90th_percentile": 36.09, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID JR3.5 VSTA BRT TIP 7FRX100CM", "code_information": [ { "code": "SUP-10157", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 54.87, "maximum": 299.86, "setting": "outpatient", "gross_charge": 299.86, "discounted_cash": 209.9, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 224.9, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 224.9, "10th_percentile": 224.9, "90th_percentile": 224.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 134.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 134.94, "10th_percentile": 134.94, "90th_percentile": 134.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 233.89, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 233.89, "10th_percentile": 233.89, "90th_percentile": 233.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 200.61, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 200.61, "10th_percentile": 200.61, "90th_percentile": 200.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 275.87, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 275.87, "10th_percentile": 275.87, "90th_percentile": 275.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 194.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 194.91, "10th_percentile": 194.91, "90th_percentile": 194.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 150.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 150.53, "10th_percentile": 150.53, "90th_percentile": 150.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 159.23, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 159.23, "10th_percentile": 159.23, "90th_percentile": 159.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 226.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 226.69, "10th_percentile": 226.69, "90th_percentile": 226.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 158.03, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 167.62, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 167.62, "10th_percentile": 167.62, "90th_percentile": 167.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 107.65, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 107.65, "10th_percentile": 107.65, "90th_percentile": 107.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 101.95, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 101.95, "10th_percentile": 101.95, "90th_percentile": 101.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 225.19, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 225.19, "10th_percentile": 225.19, "90th_percentile": 225.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 54.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 54.87, "10th_percentile": 54.87, "90th_percentile": 54.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 202.11, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 202.11, "10th_percentile": 202.11, "90th_percentile": 202.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID LCB VSTA BRT T", "code_information": [ { "code": "SUP-26326", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 54.87, "maximum": 299.86, "setting": "outpatient", "gross_charge": 299.86, "discounted_cash": 209.9, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 224.9, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 224.9, "10th_percentile": 224.9, "90th_percentile": 224.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 134.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 134.94, "10th_percentile": 134.94, "90th_percentile": 134.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 233.89, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 233.89, "10th_percentile": 233.89, "90th_percentile": 233.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 200.61, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 200.61, "10th_percentile": 200.61, "90th_percentile": 200.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 275.87, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 275.87, "10th_percentile": 275.87, "90th_percentile": 275.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 194.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 194.91, "10th_percentile": 194.91, "90th_percentile": 194.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 150.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 150.53, "10th_percentile": 150.53, "90th_percentile": 150.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 159.23, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 159.23, "10th_percentile": 159.23, "90th_percentile": 159.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 226.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 226.69, "10th_percentile": 226.69, "90th_percentile": 226.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 158.03, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 167.62, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 167.62, "10th_percentile": 167.62, "90th_percentile": 167.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 107.65, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 107.65, "10th_percentile": 107.65, "90th_percentile": 107.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 101.95, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 101.95, "10th_percentile": 101.95, "90th_percentile": 101.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 225.19, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 225.19, "10th_percentile": 225.19, "90th_percentile": 225.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 54.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 54.87, "10th_percentile": 54.87, "90th_percentile": 54.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 202.11, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 202.11, "10th_percentile": 202.11, "90th_percentile": 202.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID MAC3 LNCHR 5FRX100CM", "code_information": [ { "code": "SUP-355008", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 57.43, "maximum": 313.81, "setting": "outpatient", "gross_charge": 313.81, "discounted_cash": 219.67, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 165.38, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 166.63, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 166.63, "10th_percentile": 166.63, "90th_percentile": 166.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 237.24, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 237.24, "10th_percentile": 237.24, "90th_percentile": 237.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 235.36, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 235.36, "10th_percentile": 235.36, "90th_percentile": 235.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 175.42, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 175.42, "10th_percentile": 175.42, "90th_percentile": 175.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 209.94, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 209.94, "10th_percentile": 209.94, "90th_percentile": 209.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 157.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 157.53, "10th_percentile": 157.53, "90th_percentile": 157.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 244.77, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 244.77, "10th_percentile": 244.77, "90th_percentile": 244.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 141.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 141.21, "10th_percentile": 141.21, "90th_percentile": 141.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 288.71, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 288.71, "10th_percentile": 288.71, "90th_percentile": 288.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 203.98, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 203.98, "10th_percentile": 203.98, "90th_percentile": 203.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 211.51, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 211.51, "10th_percentile": 211.51, "90th_percentile": 211.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 235.67, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 235.67, "10th_percentile": 235.67, "90th_percentile": 235.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 112.66, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 112.66, "10th_percentile": 112.66, "90th_percentile": 112.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 106.7, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 106.7, "10th_percentile": 106.7, "90th_percentile": 106.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 57.43, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 57.43, "10th_percentile": 57.43, "90th_percentile": 57.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 208.34, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 208.34, "10th_percentile": 208.34, "90th_percentile": 208.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 208.34, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 208.34, "10th_percentile": 208.34, "90th_percentile": 208.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 222.81, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 222.81, "10th_percentile": 222.81, "90th_percentile": 222.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 222.81, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 222.81, "10th_percentile": 222.81, "90th_percentile": 222.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 189.54, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.54, "10th_percentile": 189.54, "90th_percentile": 189.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 189.54, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.54, "10th_percentile": 189.54, "90th_percentile": 189.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 189.54, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.54, "10th_percentile": 189.54, "90th_percentile": 189.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price", "median_amount": 36.09, "10th_percentile": 36.09, "90th_percentile": 36.09, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price", "median_amount": 36.09, "10th_percentile": 36.09, "90th_percentile": 36.09, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID RCB VSTA BRT TIP 6FRX100CM", "code_information": [ { "code": "SUP-59062", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 54.87, "maximum": 299.86, "setting": "outpatient", "gross_charge": 299.86, "discounted_cash": 209.9, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 224.9, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 224.9, "10th_percentile": 224.9, "90th_percentile": 224.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 134.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 134.94, "10th_percentile": 134.94, "90th_percentile": 134.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 233.89, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 233.89, "10th_percentile": 233.89, "90th_percentile": 233.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 200.61, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 200.61, "10th_percentile": 200.61, "90th_percentile": 200.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 275.87, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 275.87, "10th_percentile": 275.87, "90th_percentile": 275.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 194.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 194.91, "10th_percentile": 194.91, "90th_percentile": 194.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 150.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 150.53, "10th_percentile": 150.53, "90th_percentile": 150.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 159.23, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 159.23, "10th_percentile": 159.23, "90th_percentile": 159.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 226.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 226.69, "10th_percentile": 226.69, "90th_percentile": 226.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 158.03, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 167.62, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 167.62, "10th_percentile": 167.62, "90th_percentile": 167.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 107.65, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 107.65, "10th_percentile": 107.65, "90th_percentile": 107.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 101.95, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 101.95, "10th_percentile": 101.95, "90th_percentile": 101.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 225.19, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 225.19, "10th_percentile": 225.19, "90th_percentile": 225.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 54.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 54.87, "10th_percentile": 54.87, "90th_percentile": 54.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 202.11, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 202.11, "10th_percentile": 202.11, "90th_percentile": 202.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID STR DST SHP X", "code_information": [ { "code": "SUP-308493", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 380.8, "maximum": 2080.85, "setting": "outpatient", "gross_charge": 2080.85, "discounted_cash": 1456.59, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1789.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1789.53, "10th_percentile": 1789.53, "90th_percentile": 1789.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1789.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1789.53, "10th_percentile": 1789.53, "90th_percentile": 1789.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1789.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1789.53, "10th_percentile": 1789.53, "90th_percentile": 1789.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1789.53, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1789.53, "10th_percentile": 1789.53, "90th_percentile": 1789.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1256.83, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1256.83, "10th_percentile": 1256.83, "90th_percentile": 1256.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1256.83, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1256.83, "10th_percentile": 1256.83, "90th_percentile": 1256.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1256.83, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1256.83, "10th_percentile": 1256.83, "90th_percentile": 1256.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1381.48, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1381.48, "10th_percentile": 1381.48, "90th_percentile": 1381.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1381.48, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1381.48, "10th_percentile": 1381.48, "90th_percentile": 1381.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2080.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2080.85, "10th_percentile": 2080.85, "90th_percentile": 2080.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2080.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2080.85, "10th_percentile": 2080.85, "90th_percentile": 2080.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1477.4, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1477.4, "10th_percentile": 1477.4, "90th_percentile": 1477.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1477.4, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1477.4, "10th_percentile": 1477.4, "90th_percentile": 1477.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 380.8, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 380.8, "10th_percentile": 380.8, "90th_percentile": 380.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 747.03, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 747.03, "10th_percentile": 747.03, "90th_percentile": 747.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1402.49, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1402.49, "10th_percentile": 1402.49, "90th_percentile": 1402.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1562.72, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1562.72, "10th_percentile": 1562.72, "90th_percentile": 1562.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 707.49, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 707.49, "10th_percentile": 707.49, "90th_percentile": 707.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 1096.61, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2080.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2080.85, "10th_percentile": 2080.85, "90th_percentile": 2080.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1623.06, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1623.06, "10th_percentile": 1623.06, "90th_percentile": 1623.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 1044.59, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1044.59, "10th_percentile": 1044.59, "90th_percentile": 1044.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1573.12, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1573.12, "10th_percentile": 1573.12, "90th_percentile": 1573.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 936.38, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 936.38, "10th_percentile": 936.38, "90th_percentile": 936.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1163.2, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1163.2, "10th_percentile": 1163.2, "90th_percentile": 1163.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 2080.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 2080.85, "10th_percentile": 2080.85, "90th_percentile": 2080.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1914.38, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1914.38, "10th_percentile": 1914.38, "90th_percentile": 1914.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1352.55, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1352.55, "10th_percentile": 1352.55, "90th_percentile": 1352.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 1104.93, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1104.93, "10th_percentile": 1104.93, "90th_percentile": 1104.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1560.64, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1560.64, "10th_percentile": 1560.64, "90th_percentile": 1560.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1392.09, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1392.09, "10th_percentile": 1392.09, "90th_percentile": 1392.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.58, "10th_percentile": 143.58, "90th_percentile": 143.58, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.58, "10th_percentile": 143.58, "90th_percentile": 143.58, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.58, "10th_percentile": 143.58, "90th_percentile": 143.58, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.58, "10th_percentile": 143.58, "90th_percentile": 143.58, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.58, "10th_percentile": 143.58, "90th_percentile": 143.58, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.58, "10th_percentile": 143.58, "90th_percentile": 143.58, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 143.58, "10th_percentile": 143.58, "90th_percentile": 143.58, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 6.9% = $143.58 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 11.5% = $239.30 due to $0.00 Claim Price", "median_amount": 239.3, "10th_percentile": 239.3, "90th_percentile": 239.3, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 11.5% = $239.30 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 11.5% = $239.30 due to $0.00 Claim Price", "median_amount": 239.3, "10th_percentile": 239.3, "90th_percentile": 239.3, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,080.85 @ 11.5% = $239.30 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2080.85, "10th_percentile": 2080.85, "90th_percentile": 2080.85, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID XBLAD4 VSTA BR", "code_information": [ { "code": "SUP-143442", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 54.87, "maximum": 299.86, "setting": "outpatient", "gross_charge": 299.86, "discounted_cash": 209.9, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 224.9, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 224.9, "10th_percentile": 224.9, "90th_percentile": 224.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 134.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 134.94, "10th_percentile": 134.94, "90th_percentile": 134.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 233.89, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 233.89, "10th_percentile": 233.89, "90th_percentile": 233.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 200.61, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 200.61, "10th_percentile": 200.61, "90th_percentile": 200.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 275.87, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 275.87, "10th_percentile": 275.87, "90th_percentile": 275.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 194.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 194.91, "10th_percentile": 194.91, "90th_percentile": 194.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 150.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 150.53, "10th_percentile": 150.53, "90th_percentile": 150.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 159.23, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 159.23, "10th_percentile": 159.23, "90th_percentile": 159.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 226.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 226.69, "10th_percentile": 226.69, "90th_percentile": 226.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 158.03, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 167.62, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 167.62, "10th_percentile": 167.62, "90th_percentile": 167.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 107.65, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 107.65, "10th_percentile": 107.65, "90th_percentile": 107.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 101.95, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 101.95, "10th_percentile": 101.95, "90th_percentile": 101.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 225.19, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 225.19, "10th_percentile": 225.19, "90th_percentile": 225.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 54.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 54.87, "10th_percentile": 54.87, "90th_percentile": 54.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 202.11, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 202.11, "10th_percentile": 202.11, "90th_percentile": 202.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUID XBLAD4 VSTA BR", "code_information": [ { "code": "SUP-143445", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 54.87, "maximum": 299.86, "setting": "outpatient", "gross_charge": 299.86, "discounted_cash": 209.9, "payers_information": [ { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 224.9, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 224.9, "10th_percentile": 224.9, "90th_percentile": 224.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 134.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 134.94, "10th_percentile": 134.94, "90th_percentile": 134.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 233.89, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 233.89, "10th_percentile": 233.89, "90th_percentile": 233.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 200.61, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 200.61, "10th_percentile": 200.61, "90th_percentile": 200.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 275.87, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 275.87, "10th_percentile": 275.87, "90th_percentile": 275.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 194.91, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 194.91, "10th_percentile": 194.91, "90th_percentile": 194.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 150.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 150.53, "10th_percentile": 150.53, "90th_percentile": 150.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 159.23, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 159.23, "10th_percentile": 159.23, "90th_percentile": 159.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 226.69, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 226.69, "10th_percentile": 226.69, "90th_percentile": 226.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 158.03, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 167.62, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 167.62, "10th_percentile": 167.62, "90th_percentile": 167.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 107.65, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 107.65, "10th_percentile": 107.65, "90th_percentile": 107.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 101.95, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 101.95, "10th_percentile": 101.95, "90th_percentile": 101.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 225.19, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 225.19, "10th_percentile": 225.19, "90th_percentile": 225.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 54.87, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 54.87, "10th_percentile": 54.87, "90th_percentile": 54.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 202.11, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 202.11, "10th_percentile": 202.11, "90th_percentile": 202.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 199.08, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 199.08, "10th_percentile": 199.08, "90th_percentile": 199.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 212.9, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 212.9, "10th_percentile": 212.9, "90th_percentile": 212.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 181.12, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 181.12, "10th_percentile": 181.12, "90th_percentile": 181.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 299.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 257.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20.69, "10th_percentile": 20.69, "90th_percentile": 20.69, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 6.9% = $20.69 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price", "median_amount": 34.48, "10th_percentile": 34.48, "90th_percentile": 34.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $299.86 @ 11.5% = $34.48 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 299.86, "10th_percentile": 299.86, "90th_percentile": 299.86, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO GUIDING CORNARY AL1.5 LAUNCHER 6FRX90CM", "code_information": [ { "code": "SUP-335710", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 57.43, "maximum": 313.81, "setting": "outpatient", "gross_charge": 313.81, "discounted_cash": 219.67, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 165.38, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 166.63, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 166.63, "10th_percentile": 166.63, "90th_percentile": 166.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 237.24, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 237.24, "10th_percentile": 237.24, "90th_percentile": 237.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 235.36, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 235.36, "10th_percentile": 235.36, "90th_percentile": 235.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 175.42, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 175.42, "10th_percentile": 175.42, "90th_percentile": 175.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 209.94, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 209.94, "10th_percentile": 209.94, "90th_percentile": 209.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 157.53, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 157.53, "10th_percentile": 157.53, "90th_percentile": 157.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 244.77, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 244.77, "10th_percentile": 244.77, "90th_percentile": 244.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 141.21, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 141.21, "10th_percentile": 141.21, "90th_percentile": 141.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 288.71, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 288.71, "10th_percentile": 288.71, "90th_percentile": 288.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 203.98, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 203.98, "10th_percentile": 203.98, "90th_percentile": 203.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 211.51, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 211.51, "10th_percentile": 211.51, "90th_percentile": 211.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 235.67, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 235.67, "10th_percentile": 235.67, "90th_percentile": 235.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 112.66, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 112.66, "10th_percentile": 112.66, "90th_percentile": 112.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 106.7, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 106.7, "10th_percentile": 106.7, "90th_percentile": 106.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 57.43, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 57.43, "10th_percentile": 57.43, "90th_percentile": 57.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 208.34, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 208.34, "10th_percentile": 208.34, "90th_percentile": 208.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 208.34, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 208.34, "10th_percentile": 208.34, "90th_percentile": 208.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 222.81, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 222.81, "10th_percentile": 222.81, "90th_percentile": 222.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 222.81, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 222.81, "10th_percentile": 222.81, "90th_percentile": 222.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 189.54, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.54, "10th_percentile": 189.54, "90th_percentile": 189.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 189.54, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.54, "10th_percentile": 189.54, "90th_percentile": 189.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 189.54, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.54, "10th_percentile": 189.54, "90th_percentile": 189.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 269.88, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 269.88, "10th_percentile": 269.88, "90th_percentile": 269.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 313.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21.65, "10th_percentile": 21.65, "90th_percentile": 21.65, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 6.9% = $21.65 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price", "median_amount": 36.09, "10th_percentile": 36.09, "90th_percentile": 36.09, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price", "median_amount": 36.09, "10th_percentile": 36.09, "90th_percentile": 36.09, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $313.81 @ 11.5% = $36.09 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 313.81, "10th_percentile": 313.81, "90th_percentile": 313.81, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO INFUS 2.3FRX150CM 4", "code_information": [ { "code": "SUP-55777", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1080.31, "maximum": 5903.36, "setting": "outpatient", "gross_charge": 5903.36, "discounted_cash": 4132.35, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5076.89, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5076.89, "10th_percentile": 5076.89, "90th_percentile": 5076.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5076.89, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5076.89, "10th_percentile": 5076.89, "90th_percentile": 5076.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5076.89, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5076.89, "10th_percentile": 5076.89, "90th_percentile": 5076.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 5076.89, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 5076.89, "10th_percentile": 5076.89, "90th_percentile": 5076.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3565.63, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3565.63, "10th_percentile": 3565.63, "90th_percentile": 3565.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3565.63, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3565.63, "10th_percentile": 3565.63, "90th_percentile": 3565.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3565.63, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3565.63, "10th_percentile": 3565.63, "90th_percentile": 3565.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 3919.24, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 3919.24, "10th_percentile": 3919.24, "90th_percentile": 3919.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 3919.24, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 3919.24, "10th_percentile": 3919.24, "90th_percentile": 3919.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5903.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5903.36, "10th_percentile": 5903.36, "90th_percentile": 5903.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5903.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5903.36, "10th_percentile": 5903.36, "90th_percentile": 5903.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4191.39, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4191.39, "10th_percentile": 4191.39, "90th_percentile": 4191.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 4191.39, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4191.39, "10th_percentile": 4191.39, "90th_percentile": 4191.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 1080.31, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 1080.31, "10th_percentile": 1080.31, "90th_percentile": 1080.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 2119.31, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 2119.31, "10th_percentile": 2119.31, "90th_percentile": 2119.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 3978.86, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3978.86, "10th_percentile": 3978.86, "90th_percentile": 3978.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 4433.42, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 4433.42, "10th_percentile": 4433.42, "90th_percentile": 4433.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 2007.14, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 2007.14, "10th_percentile": 2007.14, "90th_percentile": 2007.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 3111.07, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 5903.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 5903.36, "10th_percentile": 5903.36, "90th_percentile": 5903.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 4604.62, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 4604.62, "10th_percentile": 4604.62, "90th_percentile": 4604.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 2963.49, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2963.49, "10th_percentile": 2963.49, "90th_percentile": 2963.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 4462.94, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 4462.94, "10th_percentile": 4462.94, "90th_percentile": 4462.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 2656.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 2656.51, "10th_percentile": 2656.51, "90th_percentile": 2656.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3299.98, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3299.98, "10th_percentile": 3299.98, "90th_percentile": 3299.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 5903.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 5903.36, "10th_percentile": 5903.36, "90th_percentile": 5903.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 5431.09, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 5431.09, "10th_percentile": 5431.09, "90th_percentile": 5431.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 3837.18, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 3837.18, "10th_percentile": 3837.18, "90th_percentile": 3837.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 3134.68, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3134.68, "10th_percentile": 3134.68, "90th_percentile": 3134.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 4427.52, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 4427.52, "10th_percentile": 4427.52, "90th_percentile": 4427.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 3949.35, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3949.35, "10th_percentile": 3949.35, "90th_percentile": 3949.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 407.33, "10th_percentile": 407.33, "90th_percentile": 407.33, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 407.33, "10th_percentile": 407.33, "90th_percentile": 407.33, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 407.33, "10th_percentile": 407.33, "90th_percentile": 407.33, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 407.33, "10th_percentile": 407.33, "90th_percentile": 407.33, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 407.33, "10th_percentile": 407.33, "90th_percentile": 407.33, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 407.33, "10th_percentile": 407.33, "90th_percentile": 407.33, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 407.33, "10th_percentile": 407.33, "90th_percentile": 407.33, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 6.9% = $407.33 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 11.5% = $678.89 due to $0.00 Claim Price", "median_amount": 678.89, "10th_percentile": 678.89, "90th_percentile": 678.89, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 11.5% = $678.89 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 11.5% = $678.89 due to $0.00 Claim Price", "median_amount": 678.89, "10th_percentile": 678.89, "90th_percentile": 678.89, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,903.36 @ 11.5% = $678.89 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5903.36, "10th_percentile": 5903.36, "90th_percentile": 5903.36, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO INFUS 20CM PAT UNI-FUSE 4FRX90CM", "code_information": [ { "code": "SUP-120082", "type": "CDM" }, { "code": "C1751", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 313.94, "maximum": 1715.51, "setting": "outpatient", "gross_charge": 1715.51, "discounted_cash": 1200.86, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1475.34, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1475.34, "10th_percentile": 1475.34, "90th_percentile": 1475.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1475.34, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1475.34, "10th_percentile": 1475.34, "90th_percentile": 1475.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1475.34, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1475.34, "10th_percentile": 1475.34, "90th_percentile": 1475.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1475.34, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1475.34, "10th_percentile": 1475.34, "90th_percentile": 1475.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1036.17, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1036.17, "10th_percentile": 1036.17, "90th_percentile": 1036.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1036.17, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1036.17, "10th_percentile": 1036.17, "90th_percentile": 1036.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1036.17, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1036.17, "10th_percentile": 1036.17, "90th_percentile": 1036.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1138.93, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1138.93, "10th_percentile": 1138.93, "90th_percentile": 1138.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1138.93, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1138.93, "10th_percentile": 1138.93, "90th_percentile": 1138.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1218.01, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1218.01, "10th_percentile": 1218.01, "90th_percentile": 1218.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1218.01, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1218.01, "10th_percentile": 1218.01, "90th_percentile": 1218.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1715.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1715.51, "10th_percentile": 1715.51, "90th_percentile": 1715.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1715.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1715.51, "10th_percentile": 1715.51, "90th_percentile": 1715.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1156.25, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1156.25, "10th_percentile": 1156.25, "90th_percentile": 1156.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1288.35, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1288.35, "10th_percentile": 1288.35, "90th_percentile": 1288.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 583.27, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 583.27, "10th_percentile": 583.27, "90th_percentile": 583.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 615.87, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 615.87, "10th_percentile": 615.87, "90th_percentile": 615.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 313.94, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 313.94, "10th_percentile": 313.94, "90th_percentile": 313.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 771.98, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 771.98, "10th_percentile": 771.98, "90th_percentile": 771.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 958.97, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 958.97, "10th_percentile": 958.97, "90th_percentile": 958.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1715.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1715.51, "10th_percentile": 1715.51, "90th_percentile": 1715.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 1115.08, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 1115.08, "10th_percentile": 1115.08, "90th_percentile": 1115.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 910.94, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 910.94, "10th_percentile": 910.94, "90th_percentile": 910.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1715.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1715.51, "10th_percentile": 1715.51, "90th_percentile": 1715.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 861.19, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 861.19, "10th_percentile": 861.19, "90th_percentile": 861.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1578.27, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1578.27, "10th_percentile": 1578.27, "90th_percentile": 1578.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC HMO/PPO", "standard_charge_dollar": 1147.68, "standard_charge_percentage": 66.9, "standard_charge_algorithm": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1147.68, "10th_percentile": 1147.68, "90th_percentile": 1147.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 66.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1296.93, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1296.93, "10th_percentile": 1296.93, "90th_percentile": 1296.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1338.1, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1338.1, "10th_percentile": 1338.1, "90th_percentile": 1338.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "KH SEIU HEALTHLINK", "standard_charge_dollar": 1286.63, "standard_charge_percentage": 75.0, "standard_charge_algorithm": "Outpatient Services; 75% Billed", "median_amount": 1286.63, "10th_percentile": 1286.63, "90th_percentile": 1286.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 75% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 904.07, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 904.07, "10th_percentile": 904.07, "90th_percentile": 904.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE MEDICAID [1310]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.37, "10th_percentile": 118.37, "90th_percentile": 118.37, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MERIDIAN HEALTH PLAN HMO [1604]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.37, "10th_percentile": 118.37, "90th_percentile": 118.37, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CENPATICO BEHAVIORAL HEALTH [1603]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.37, "10th_percentile": 118.37, "90th_percentile": 118.37, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CIGNA HEALTHSPRING SPECIALCARE OF IL [1608]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.37, "10th_percentile": 118.37, "90th_percentile": 118.37, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "FAMILY HEALTH NETWORK HMO [1610]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.37, "10th_percentile": 118.37, "90th_percentile": 118.37, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS MEDICAID [1612]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.37, "10th_percentile": 118.37, "90th_percentile": 118.37, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "COUNTYCARE IL COOK CO [1607]", "plan_name": "KH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.37, "10th_percentile": 118.37, "90th_percentile": 118.37, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR CDH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 6.9% = $118.37 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 11.5% = $197.28 due to $0.00 Claim Price", "median_amount": 197.28, "10th_percentile": 197.28, "90th_percentile": 197.28, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 11.5% = $197.28 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "KH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 11.5% = $197.28 due to $0.00 Claim Price", "median_amount": 197.28, "10th_percentile": 197.28, "90th_percentile": 197.28, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - CDH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR CDH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,715.51 @ 11.5% = $197.28 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "KH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1715.51, "10th_percentile": 1715.51, "90th_percentile": 1715.51, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "CATH ANGIO SUPP STRT TIP NAVICROSS 0.035INX90CM", "code_information": [ { "code": "SUP-358623", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 276.42, "maximum": 1510.48, "setting": "outpatient", "gross_charge": 1510.48, "discounted_cash": 1057.34, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1299.01, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1299.01, "10th_percentile": 1299.01, "90th_percentile": 1299.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1299.01, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1299.01, "10th_percentile": 1299.01, "90th_percentile": 1299.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRYONE PPO [17110]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1299.01, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1299.01, "10th_percentile": 1299.01, "90th_percentile": 1299.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "COVENTRY [1218]", "plan_name": "KH PERSONAL CARE", "standard_charge_dollar": 1299.01, "standard_charge_percentage": 86.0, "standard_charge_algorithm": "All Services; 86% Billed", "median_amount": 1299.01, "10th_percentile": 1299.01, "90th_percentile": 1299.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 86% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 912.33, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 912.33, "10th_percentile": 912.33, "90th_percentile": 912.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 912.33, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 912.33, "10th_percentile": 912.33, "90th_percentile": 912.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 912.33, "standard_charge_percentage": 60.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 912.33, "10th_percentile": 912.33, "90th_percentile": 912.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 60.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1002.81, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1002.81, "10th_percentile": 1002.81, "90th_percentile": 1002.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS HMO", "standard_charge_dollar": 1002.81, "standard_charge_percentage": 66.39, "standard_charge_algorithm": "Outpatient; 66.39% Billed", "median_amount": 1002.81, "10th_percentile": 1002.81, "90th_percentile": 1002.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 66.39% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1510.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1510.48, "10th_percentile": 1510.48, "90th_percentile": 1510.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1510.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1510.48, "10th_percentile": 1510.48, "90th_percentile": 1510.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1072.44, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1072.44, "10th_percentile": 1072.44, "90th_percentile": 1072.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "KH BCBS PPO", "standard_charge_dollar": 1072.44, "standard_charge_percentage": 71.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1072.44, "10th_percentile": 1072.44, "90th_percentile": 1072.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 71% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NM EMPLOYEES", "standard_charge_dollar": 276.42, "standard_charge_percentage": 18.3, "standard_charge_algorithm": "All Services; 18.3% Billed", "median_amount": 276.42, "10th_percentile": 276.42, "90th_percentile": 276.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 18.3% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA IL PREFERRED", "standard_charge_dollar": 542.26, "standard_charge_percentage": 35.9, "standard_charge_algorithm": "All Outpatient Services; 35.9% Billed", "median_amount": 542.26, "10th_percentile": 542.26, "90th_percentile": 542.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Outpatient Services; 35.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA", "standard_charge_dollar": 1018.06, "standard_charge_percentage": 67.4, "standard_charge_algorithm": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1018.06, "10th_percentile": 1018.06, "90th_percentile": 1018.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 67.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA ASA", "standard_charge_dollar": 1134.37, "standard_charge_percentage": 75.1, "standard_charge_algorithm": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1134.37, "10th_percentile": 1134.37, "90th_percentile": 1134.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient Services; 75.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "KH AETNA NIU", "standard_charge_dollar": 513.56, "standard_charge_percentage": 34.0, "standard_charge_algorithm": "ALL OUTPATIENT; 34% Billed", "median_amount": 513.56, "10th_percentile": 513.56, "90th_percentile": 513.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OUTPATIENT; 34% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA BROAD", "standard_charge_dollar": 796.02, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 165.38, "10th_percentile": 165.38, "90th_percentile": 165.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1510.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1510.48, "10th_percentile": 1510.48, "90th_percentile": 1510.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "KH MULTIPLAN", "standard_charge_dollar": 1178.17, "standard_charge_percentage": 78.0, "standard_charge_algorithm": "All Services; 78% Billed", "median_amount": 1178.17, "10th_percentile": 1178.17, "90th_percentile": 1178.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 78% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "KH UHC CORE", "standard_charge_dollar": 758.26, "standard_charge_percentage": 50.2, "standard_charge_algorithm": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 758.26, "10th_percentile": 758.26, "90th_percentile": 758.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 50.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "CHOICECARE [177]", "plan_name": "KH CHOICE CARE", "standard_charge_dollar": 1141.92, "standard_charge_percentage": 75.6, "standard_charge_algorithm": "Outpatient; 75.6% Billed", "median_amount": 1141.92, "10th_percentile": 1141.92, "90th_percentile": 1141.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient; 75.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN NMH TIER ONE", "standard_charge_dollar": 679.72, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "ALL OTH SRVS; 45% Billed", "median_amount": 679.72, "10th_percentile": 679.72, "90th_percentile": 679.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "ALL OTH SRVS; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "KH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 844.36, "standard_charge_percentage": 55.9, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 844.36, "10th_percentile": 844.36, "90th_percentile": 844.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 55.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "OPTUM/UNITED BEHAVIORAL HEALTH [157]", "plan_name": "KH OPTUM UBH BHS PROF", "standard_charge_dollar": 1510.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other - NEEDS DMC REVIEW; 100% Billed", "median_amount": 1510.48, "10th_percentile": 1510.48, "90th_percentile": 1510.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other - NEEDS DMC REVIEW; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "KH HFN", "standard_charge_dollar": 1389.64, "standard_charge_percentage": 92.0, "standard_charge_algorithm": "All Services; 92% Billed", "median_amount": 1389.64, "10th_percentile": 1389.64, "90th_percentile": 1389.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 92% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "KH THE ALLIANCE", "standard_charge_dollar": 981.81, "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges.", "median_amount": 981.81, "10th_percentile": 981.81, "90th_percentile": 981.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 80% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 80% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "KH CIGNA ALTERNATIVE", "standard_charge_dollar": 802.06, "standard_charge_percentage": 53.1, "standard_charge_algorithm": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 802.06, "10th_percentile": 802.06, "90th_percentile": 802.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]",